LONG-TERM OUTCOME OF ELBOW RESECTION FOR THE SALVAGE OF THE INFECTED TOTAL ELBOW ARTHROPLASTY: J Sánchez-Sotelo; PC Zarkadas; B Cass; T Throckmorton; BF Morrey.

Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota, United States;

Department of Orthopaedic Surgery, Mayo Clinic, Vancouver, Canadá;

Department of Orthopaedic Surgery, Mayo Clinic, Adelaide, Australia;

Department of Orthopaedic Surgery, Mayo Clinic, Memphis, United States;

Purpose: Elbow resection is a salvage procedure typically considered as a last resort in the case of refractory infection following elbow arthroplasty. The goal of this study was to evaluate the long-term outcome of patients following elbow resection for the infected total elbow.

Material and Methods: Between 1975 and 2005, 51 consecutive elbows (50 patients, 32 females and 19 males) were treated at our institution with a definitive elbow resection for a deep infection following total elbow arthroplasty. The average age at the time of elbow resection was 59.0 ± 15.6 years (range 25-90). All patients were followed for an average of 1.7 years. At the time of most recent follow-up, 16 patients had died, and 5 had been lost to follow-up, leaving 29 patients (30 elbows) for review at an average 11 years (range 2.7 to 28 years). Clinical results were graded using the MEPS andDASH scores at the most recent follow-up.

Results

The MEPS improved significantly from a pre-operative value of 37.2 to a score of 58.8 in the short-term, which was maintained in the long-term at 57.7 points (p = 0.0001). Most of the improvement in MEPS was due to the improvement in the pain score. The DASH score averaged 71 points (range 51 to 91 points) at 11 years. Staphylococcus was the most common bacterial isolate (54.8%). Complications were common, including included intra-operative fracture (35.3%), nerve injury (17.6%), and persistent infection requiring re-operation (47%). Achieving a stable resected elbow correlated with a good long-term MEPS score (r = 0.75). 63% of patients were considered to have a fair to good outcome in the long-term according to the MEPS.

Conclusion: Resection arthroplasty provides a reasonable outcome in approximately two thirds of the patients following resection for infection after total elbow arthroplasty. This procedure should only be considered as a salvage procedure when all other attempts to eradicate the infection have failed. A stable elbow resection correlated with superior long-term result.