Characteristics of elbow prosthetic joint infection: a 13-year retrospective analysis of 358 elbow prostheses
Abstract number: O389
Achermann Y., Spormann C., Kolling C., Remschmidt C., Wüst J., Simmen B., Vogt M.
Objectives: Elbow arthroplasty is increasingly used for treatment of rheumatic or posttraumatic arthritis. Data on epidemiology, characteristics and treatment outcome of elbow prosthetic joint infection (PJI) is limited. Furthermore, no validated therapeutic algorithm exist as for hip or knee PJI. We analyzed all PJI, which occurred in a cohort of implanted elbow prostheses during a 13-year-period.
Methods: Between 01/1994 and 12/2007, all cases with implanted elbow prosthesis at our institution were retrospectively included. Elbow PJI was defined as visible purulence, acute inflammation on histopathology, sinus tract or microbial growth in periprosthetic tissue. Patients were regularly follow-up at outpatient orthopedic visits and were in addition recently contacted by phone. A Kaplan-Meier survival analysis was performed.
Results: During the study period, 358 elbow prostheses were implanted. Overall, 25 of 358 cases (7%) developed elbow PJI (median age 61 y, range 4182 y, 40% males). Among them, 14 (56%) had a rheumatic disorder and 11 (44%) a posttraumatic arthritis. 12 infections were early ( 3 months), 3 were delayed (324 months) and 10 were late ( 24 months). More infections were acquired intraoperatively (n = 15, 60%) than haematogenously (n = 10, 40%). The following pathogens were cultured: Staphylococcus aureus (n = 11), coagulase-negative staphylococci (n = 7), Streptococcus agalactiae (n = 2), Corynebacterium sp. (n = 1), Enterococcus sp. (n = 1), Enterobacter cloacae (n = 1), mixed infections (n = 1) and culture-negative (n = 1). Treatment approaches included débridement with implant retention (n = 19), one-stage exchange (n = 2), two-stage exchange (n = 1), resection arthroplasty (1) and antibiotics only (n = 2). At follow-up, 16 (64%) patients were free of infection (median follow-up time 2.6 y, range 0.711.3 y) and 9 (36%) had a relapse (median time to infection 0.4 y, range 0.14.0 y). One patient died due to infectious endocarditis with secondary haematogenous elbow PJI. The relapse-free survival (95% confidence interval) was 75% (58%-93%) after 1 year, 70% (52%-89%) after 2 years, 62% (39%-85%) after 3 years and 52% (27%-78%) after 4 years.
Conclusions: The infection incidence after elbow arthroplasty was higher (7%) than reported after hip (<1%) or knee arthroplasty (<2%). Most infections (48%) manifested early ( 3 months). Underlying rheumatic disorder were common in elbow PJI (58%). The relapse-free survival after elbow PJI was 75%, 70%, 62% and 52% after 1, 2, 3 and 4 years.
|Session name:||19th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Helsinki, Finland, 16 - 19 May 2009|
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