The Journal of Bone and Joint Surgery, Vol 72, Issue 2 198-212, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Management of infection about total elbow prostheses
SW Wolfe, MP Figgie, AE Inglis, WW Bohn and CS Ranawat
Hospital for Special Surgery, Cornell University Medical College, New York City, N.Y. 10021.
Deep infection was a complication after twelve (7.3 per cent) of 164
primary total elbow replacements. Two additional patients who had an
infection about an elbow prosthesis were referred for treatment after total
elbow replacement elsewhere. A statistical analysis of all of these primary
total elbow arthroplasties, including the two in patients who were referred
from outside institutions, identified preoperative factors that placed a
patient at significant risk for subsequent infection. The risk factors
included a previous operation on the elbow, a previous infection in the
region of the elbow, psychiatric illness, class-IV rheumatoid arthritis,
drainage from the wound after operation, spontaneous drainage after ten
days, and reoperation for any reason. Three modes of treatment were used
for patients who had an established infection: debridement and salvage of
the implant, resection arthroplasty, and arthrodesis. After early operative
debridement and suppression of the infection with long-term antibiotic
therapy, three patients were able to retain the prosthesis, with
restoration of range of motion and function of the upper extremity. One
prosthesis was reimplanted after a six-week course of intravenous
administration of antibiotics.
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