Advertisement

Clinical results of revision total elbow arthroplasty: comparison of infected and non-infected total elbow arthroplasty

  • Jae-Man Kwak
  • Erica Kholinne
  • Yucheng Sun
  • Myung-Sun Kim
  • Kyoung-Hwan Koh
  • In-Ho JeonEmail author
Original Paper
  • 18 Downloads

Abstract

Background

Total elbow arthroplasty (TEA) is considered a successful treatment for several conditions, including rheumatoid arthritis and comminuted fractures. However, failure rates as high as 62% have been reported, with many patients requiring surgical revision. Causes of failure requiring revision can be classified as infected or non-infected. This study evaluated the clinical and radiologic outcomes of TEA revision surgery according to causes of failure.

Methods

Twenty patients undergoing revision TEAs in 2010–2015 were retrospectively evaluated. Mean follow-up was 52.7 months. Patients were categorized into infected and non-infected groups based on radiologic and serologic tests. Clinical outcomes included range of motion (ROM) and Mayo Elbow Performance Score (MEPS), and radiological outcomes included loosening signs on anteroposterior (AP) and lateral plain radiographs at final follow-up. Complications were assessed in both groups.

Results

Overall, mean MEPS was 79.7, and mean ROM arc was 97.9° at final follow-up. Nine patients underwent revision due to infection, and 11 due to non-infectious causes. Mean MEPS in these two groups was 75.6 and 83.5, respectively, and mean ROM arc for flexion-extension was 89.4° and 108°, respectively. Two (22%) of the nine patients in the infection group required second revision surgery due to recurrent infection. No patient in the non-infected group underwent second revision surgery. The most frequent complication in the infected group was osteolysis, observed in five patients, including four with symptomatic aseptic loosening and one with non-symptomatic osteolysis. Two patients in the non-infected group demonstrated a non-progressive radiolucent line, which was asymptomatic at final follow-up.

Conclusion

Revision TEA provided clinical improvement in elbow function and resulted in satisfactory outcomes. Outcomes were worse in the infected than in the non-infected groups. Comorbidities and older age were apparent risk factors for infected TEA.

Keywords

Revision Total elbow arthroplasty Infection TEA 

Notes

Compliance with ethical standards

Conflict of interests

The authors declare that there is no conflict of interest.

References

  1. 1.
    Day JS, Lau E, Ong KL, Williams GR, Ramsey ML, Kurtz SM (2010) Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015. J Shoulder Elb Surg 19(8):1115–1120.  https://doi.org/10.1016/j.jse.2010.02.009 CrossRefGoogle Scholar
  2. 2.
    Brinkman JM, de Vos MJ, Eygendaal D (2007) Failure mechanisms in uncemented Kudo type 5 elbow prosthesis in patients with rheumatoid arthritis: 7 of 49 ulnar components revised because of loosening after 2–10 years. Acta Orthop 78(2):263–270.  https://doi.org/10.1080/17453670710013780 CrossRefPubMedGoogle Scholar
  3. 3.
    Kim JM, Mudgal CS, Konopka JF, Jupiter JB (2011) Complications of total elbow arthroplasty. J Am Acad Orthop Surg 19(6):328–339CrossRefGoogle Scholar
  4. 4.
    Park SE, Kim JY, Cho SW, Rhee SK, Kwon SY (2013) Complications and revision rate compared by type of total elbow arthroplasty. J Shoulder Elb Surg 22(8):1121–1127.  https://doi.org/10.1016/j.jse.2013.03.003 CrossRefGoogle Scholar
  5. 5.
    Perretta D, van Leeuwen WF, Dyer G, Ring D, Chen N (2017) Risk factors for reoperation after total elbow arthroplasty. J Shoulder Elb Surg 26(5):824–829.  https://doi.org/10.1016/j.jse.2016.12.064 CrossRefGoogle Scholar
  6. 6.
    Kiran M, Jariwala A, Wigderowitz C (2015) Medium term outcomes of primary and revision Coonrad-Morrey total elbow replacement. Ind J Orthop 49(2):233–238.  https://doi.org/10.4103/0019-5413.152497 CrossRefGoogle Scholar
  7. 7.
    Peach CA, Nicoletti S, Lawrence TM, Stanley D (2013) Two-stage revision for the treatment of the infected total elbow arthroplasty. Bone Joint J 95-b(12):1681–1686.  https://doi.org/10.1302/0301-620x.95b12.31336 CrossRefPubMedGoogle Scholar
  8. 8.
    Viveen J, Prkic A, Koenraadt KL, Kodde IF, The B, Eygendaal D (2017) Clinical and radiographic outcome of revision surgery of total elbow prosthesis: midterm results in 19 cases. J Shoulder Elb Surg 26(4):716–722.  https://doi.org/10.1016/j.jse.2016.10.010 CrossRefGoogle Scholar
  9. 9.
    de Vos MJ, Wagener ML, Hannink G, van der Pluijm M, Verdonschot N, Eygendaal D (2016) Short-term clinical results of revision elbow arthroplasty using the latitude total elbow arthroplasty. Bone Joint J 98-b(8):1086–1092.  https://doi.org/10.1302/0301-620x.98b8.35025 CrossRefPubMedGoogle Scholar
  10. 10.
    Hozack WJ, Parvizi J (2011) New definition for periprosthetic joint infection. J Arthroplast 26(8):1135.  https://doi.org/10.1016/j.arth.2011.09.025 CrossRefGoogle Scholar
  11. 11.
    Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, Rao N, Hanssen A, Wilson WR (2013) Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 56(1):e1–e25.  https://doi.org/10.1093/cid/cis803 CrossRefPubMedGoogle Scholar
  12. 12.
    Hastings H 2nd (2004) Minimally constrained elbow implant arthroplasty: the discovery elbow system. Tech Hand Upper Extrem Surg 8(1):34–50CrossRefGoogle Scholar
  13. 13.
    Shi LL, Zurakowski D, Jones DG, Koris MJ, Thornhill TS (2007) Semiconstrained primary and revision total elbow arthroplasty with use of the Coonrad-Morrey prosthesis. J Bone Joint Surg Am 89(7):1467–1475.  https://doi.org/10.2106/jbjs.f.00715 CrossRefPubMedGoogle Scholar
  14. 14.
    Sneftrup SB, Jensen SL, Johannsen HV, Sojbjerg JO (2006) Revision of failed total elbow arthroplasty with use of a linked implant. J Bone Joint Surg Br Vol 88(1):78–83.  https://doi.org/10.1302/0301-620x.88b1.16446 CrossRefGoogle Scholar
  15. 15.
    Morrey ME, Sanchez-Sotelo J, Abdel MP, Morrey BF (2013) Allograft-prosthetic composite reconstruction for massive bone loss including catastrophic failure in total elbow arthroplasty. J Bone Joint Surg Am 95(12):1117–1124.  https://doi.org/10.2106/jbjs.l.00747 CrossRefPubMedGoogle Scholar
  16. 16.
    Ramirez MA, Cheung EV, Murthi AM (2017) Revision total elbow arthroplasty. J Am Acad Orthop Surg 25(8):e166–e174.  https://doi.org/10.5435/jaaos-d-15-00479 CrossRefPubMedGoogle Scholar
  17. 17.
    Harris WH, Schiller AL, Scholler JM, Freiberg RA, Scott R (1976) Extensive localized bone resorption in the femur following total hip replacement. J Bone Joint Surg Am 58(5):612–618CrossRefGoogle Scholar
  18. 18.
    Cheung EV, O'Driscoll SW (2007) Total elbow prosthesis loosening caused by ulnar component pistoning. J Bone Joint Surg Am 89(6):1269–1274.  https://doi.org/10.2106/jbjs.f.00376 CrossRefPubMedGoogle Scholar
  19. 19.
    Adesanya O, Sprowson A, Masters J, Hutchinson C (2015) Review of the role of dynamic 18F-NaF PET in diagnosing and distinguishing between septic and aseptic loosening in hip prosthesis. J Orthop Surg Res 10:5.  https://doi.org/10.1186/s13018-014-0147-7 CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Pruzansky JS, Bronson MJ, Grelsamer RP, Strauss E, Moucha CS (2014) Prevalence of modifiable surgical site infection risk factors in hip and knee joint arthroplasty patients at an urban academic hospital. J Arthroplast 29(2):272–276.  https://doi.org/10.1016/j.arth.2013.06.019 CrossRefGoogle Scholar
  21. 21.
    Renfree KJ, Dell PC, Kozin SH, Wright TW (2004) Total elbow arthroplasty with massive composite allografts. J Shoulder Elb Surg 13(3):313–321.  https://doi.org/10.1016/s1058274604000278 CrossRefGoogle Scholar
  22. 22.
    Hackl M, Muller LP, Leschinger T, Wegmann K (2017) Total elbow arthroplasty in traumatic and post-traumatic bone defects. Orthopade 46(12):990–1000.  https://doi.org/10.1007/s00132-017-3493-4 CrossRefPubMedGoogle Scholar
  23. 23.
    Somerson JS, Morrey ME, Sanchez-Sotelo J, Morrey BF (2015) Diagnosis and management of periprosthetic elbow infection. J Bone Joint Surg Am 97(23):1962–1971.  https://doi.org/10.2106/jbjs.o.00170 CrossRefPubMedGoogle Scholar
  24. 24.
    Duquin TR, Jacobson JA, Schleck CD, Larson DR, Sanchez-Sotelo J, Morrey BF (2014) Triceps insufficiency after the treatment of deep infection following total elbow replacement. Bone Joint J 96-b(1):82–87.  https://doi.org/10.1302/0301-620x.96b1.31127 CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  • Jae-Man Kwak
    • 1
  • Erica Kholinne
    • 2
  • Yucheng Sun
    • 1
  • Myung-Sun Kim
    • 3
  • Kyoung-Hwan Koh
    • 1
  • In-Ho Jeon
    • 1
    Email author
  1. 1.Department of Orthopedic Surgery, Asan Medical Center, College of MedicineUlsan UniversitySeoulSouth Korea
  2. 2.Department of Orthopedic SurgerySt. Carolus HospitalJakartaIndonesia
  3. 3.Department of Orthopedic SurgeryChonnam National University HospitalDong-guSouth Korea

Personalised recommendations