Michele Mercurio1, Davide Castioni2, Orlando Cosentino1, Filippo Familiari1, Bruno Iannò3, Giorgio Gasparini1, Olimpio Galasso1. 1. Department of Orthopaedic and Trauma Surgery, "Mater Domini" University Hospital, "Magna Græcia" University, V.le Europa, (Loc. Germaneto), 88100, Catanzaro, Italy. 2. Department of Orthopaedic and Trauma Surgery, "Mater Domini" University Hospital, "Magna Græcia" University, V.le Europa, (Loc. Germaneto), 88100, Catanzaro, Italy. davide.n.castioni@gmail.com. 3. Department of Surgery, Division of Orthopedics and Trauma Surgery, "G. Jazzolino" Hospital, Piazza Fleming, 89900, Vibo Valentia, Italy.
Abstract
INTRODUCTION: The aim of this systematic review was to investigate the outcomes of revision surgery after periprosthetic elbow infection (PEI). MATERIAL AND METHODS: Eighteen studies with 332 PEI that underwent revision surgery were included. Demographics, laboratory and microbiological data, types of implants, surgical techniques with complications and reoperations, eradication rates, and clinical and functional outcomes were reported. RESULTS: Staphylococcus aureus was the most common microorganism (40%). Pre-operatively, the mean white blood cell count was 8400 ± 4000 per microliter; the mean C-reactive protein level was 41.6 ± 66.9 mg/dl, and the mean erythrocyte sedimentation rate was 45 ± 66.9 mm/h. The Coonrad-Morrey total elbow prosthesis represented 41.2% of the infected implant, and it also represented the most common system used for the PEI revision surgery. Two-stage revision and debridement and implant retention (DAIR) were the most common procedures performed for PEI, and, on the whole, they represented 35.7 and 32.7%, respectively. The eradication rate was 76% with 2-stage, 71% with resection arthroplasty (RA), 66.7% with 1-stage, 57.7% with DAIR, and 40% with arthrodesis (EA). DAIR showed a significantly lower eradication rate than 2-stage (P = 0.003). The mean postoperative Mayo Elbow Performance Score was significantly higher in patients who underwent DAIR, and 2-stage compared with RA (P < 0.001 for all). Postoperative flexion-extension ROM was significantly higher in patients who underwent DAIR compared with 1-stage, 2-stage, and RA (P < 0.001 for all). Moreover, 1-stage and 2-stage showed a significantly greater postoperative flexion-extension ROM compared with RA (P < 0.001 for all). Reoperations occurred in 40% of patients after EA, 33.3% after 1-stage, 26.9% after DAIR and RA, and 24.1% after 2-stage. Conversion to amputation occurred in 2.2% of patients after RA and 1% after DAIR. CONCLUSIONS: Two-stage revision and DAIR are the most common procedures used to manage PEI; however, the former procedure showed a significantly higher eradication rate. Resection arthroplasty showed a high eradication rate, but postoperative lower clinical and functional outcomes limit the indications for this technique. One-stage procedure showed a limited role in the current practice of PEI treatment. LEVEL OF EVIDENCE: Level IV.
INTRODUCTION: The aim of this systematic review was to investigate the outcomes of revision surgery after periprosthetic elbow infection (PEI). MATERIAL AND METHODS: Eighteen studies with 332 PEI that underwent revision surgery were included. Demographics, laboratory and microbiological data, types of implants, surgical techniques with complications and reoperations, eradication rates, and clinical and functional outcomes were reported. RESULTS: Staphylococcus aureus was the most common microorganism (40%). Pre-operatively, the mean white blood cell count was 8400 ± 4000 per microliter; the mean C-reactive protein level was 41.6 ± 66.9 mg/dl, and the mean erythrocyte sedimentation rate was 45 ± 66.9 mm/h. The Coonrad-Morrey total elbow prosthesis represented 41.2% of the infected implant, and it also represented the most common system used for the PEI revision surgery. Two-stage revision and debridement and implant retention (DAIR) were the most common procedures performed for PEI, and, on the whole, they represented 35.7 and 32.7%, respectively. The eradication rate was 76% with 2-stage, 71% with resection arthroplasty (RA), 66.7% with 1-stage, 57.7% with DAIR, and 40% with arthrodesis (EA). DAIR showed a significantly lower eradication rate than 2-stage (P = 0.003). The mean postoperative Mayo Elbow Performance Score was significantly higher in patients who underwent DAIR, and 2-stage compared with RA (P < 0.001 for all). Postoperative flexion-extension ROM was significantly higher in patients who underwent DAIR compared with 1-stage, 2-stage, and RA (P < 0.001 for all). Moreover, 1-stage and 2-stage showed a significantly greater postoperative flexion-extension ROM compared with RA (P < 0.001 for all). Reoperations occurred in 40% of patients after EA, 33.3% after 1-stage, 26.9% after DAIR and RA, and 24.1% after 2-stage. Conversion to amputation occurred in 2.2% of patients after RA and 1% after DAIR. CONCLUSIONS: Two-stage revision and DAIR are the most common procedures used to manage PEI; however, the former procedure showed a significantly higher eradication rate. Resection arthroplasty showed a high eradication rate, but postoperative lower clinical and functional outcomes limit the indications for this technique. One-stage procedure showed a limited role in the current practice of PEI treatment. LEVEL OF EVIDENCE: Level IV.
Authors: Setor K Kunutsor; Matthew C Barrett; Michael R Whitehouse; Richard S Craig; Erik Lenguerrand; Andrew D Beswick; Ashley W Blom Journal: J Infect Date: 2020-01-22 Impact factor: 6.072
Authors: Y Achermann; M Vogt; C Spormann; C Kolling; C Remschmidt; J Wüst; B Simmen; A Trampuz Journal: Clin Microbiol Infect Date: 2011-03 Impact factor: 8.067
Authors: Ante Prkic; Chantal Welsink; Bertram The; Michel P J van den Bekerom; Denise Eygendaal Journal: Arch Orthop Trauma Surg Date: 2017-04-09 Impact factor: 3.067
Authors: Jeremy S Somerson; Mark E Morrey; Joaquin Sanchez-Sotelo; Bernard F Morrey Journal: J Bone Joint Surg Am Date: 2015-12-02 Impact factor: 5.284
Authors: Setor K Kunutsor; Andrew D Beswick; Michael R Whitehouse; Ashley W Blom Journal: BMC Musculoskelet Disord Date: 2019-10-22 Impact factor: 2.362