Artikel
Total arthroplasty in the treatment of previous infection of the elbow. Two-stage surgery
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Autoren
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Gerardo Gallucci
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Julieta Puig Dubois
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Ezequiel Zaidenberg
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Agustin Donndorff
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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Jorge Boretto
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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De Carli Pablo
- Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: The total replacement after a previus infection is a procedure well reported in some articulations like hip and knee; but it is not overly reported in the elbow. The infection is a difficult condition that can be associated with bad results. The two stage-surgery with an antibiotic cement spacer and a Total Elbow Arthroplasty can be a good option of treatment.
The aim of this study is to report the results of an infected elbow treated in a two stage-surgery with a total elbow arthroplasty.
Methods: We report 6 patients with a prior infection of the elbow, treated with the same procedure. First stage: debridement of the infected tissue and introduction of the antibiotic cement spacer, and reconstruction, in a second stage, with a Total Elbow Arthroplasty.
Three were woman and 3 men with a mean age of 62 years old (35-80). The causes of the infection were: 1 psoriatic arthritis, 1 reumatoid atritis, 1 cronic elbow dislocation, 1 Total Elbow Arthoplasty and 2 distal humerus fractures. All the spacers were impregnated with vancomicin.
The most commonly isolated germ was staphylococcus epidermidis. The second stage was performed at an average of 82 days. The Conrad-Morrey prosthesis was used in all cases. Allografts were used in 4 of the cases. The number of previus surgeries was 1,8 (1-8). Mean pain according to VAS was 6,5. Mean DASH was 43. Average follow-up was 83 months (30-120)
Results and Conclusions: Flexo-extension was 133-22°. Pain was 2 (0-4) and DASH 31. MEPS was 86. The strength of extension was M5 in 3, M3 in two and M4 in one. Two complications were present, 1 ulnar nerve parestesia and 1 earlier decoupling of the peg.
All patients presented normal laboratory parameters and no reactivation of the infection was reported. According to Morrey classification 3 patients had no loosening of the implant, one type 1, one type 2 and one type.
The two-stage procedure for the reconstruction of the elbow with a Total Elbow Arthoplasty in the context of a previous infection is a good option of treatment with no reactivation of the infection at an average of 7 years of follow-up.
