Is systematic 1-stage exchange a valid attitude in chronic infection of total elbow arthroplasty?

Abstract Introduction: Surgical treatment for chronic infection of total elbow arthroplasty (TEA) generally involves 2-stage exchange. In the lower limb, 1-stage strategies are increasingly implemented, but few cases have been reported for the elbow. We present results in a preliminary series, with the aim of: 1) assessing control of infection in systematic 1-stage exchange for chronic TEA infection, 2) detailing clinical and radiological results, and 3) analyzing intra- and post-operative complications. Hypothesis: Systematic 1-stage exchange for chronic TEA prosthetic joint infection provides satisfactory control of infection. Material and Methods: Seven non-selected patients were operated on by 1-stage exchange for chronic infection of TEA during the study period. Two died before the minimum 2 years’ follow-up, from causes unrelated to the infection. Thus 5 patients (4 women, 1 man; mean age at surgery, 61 years (range, 48-69 years)) were included for analysis. At a minimum 2 years’ follow-up, all underwent clinical examination and elbow X-ray. Infection was monomicrobial in 4 cases and polymicrobial in 1. Isolates comprised Staphylococcus aureus in 40% of cases (2/5), Staphylococcus epidermidis in 60% (3/5) and Staphylococcus Warneri in 20% (1/5). Three patients showed fistula. Three were under immunosuppression/immunomodulation treatment. Results: At a mean 40 months’ follow-up (range, 24-60 months), 4 patients (80%) were free of infection and 1 showed signs of persistent infection. Mean range of flexion-extension was 81° (range, 60-95°) and pronation-supination 128° (range, 80-160°). Mean Mayo Elbow Performance Score was 75 points (range, 65-90). There were 2 intraoperative fractures and 1 neurologic deficit with partial regression. Conclusion: One-stage exchange provided control of infection in 80% of cases, despite cutaneous fistulae or immunosuppression treatment. Clinical results and complications rate were similar to those reported for 2-stage exchange. Level of evidence: IV; Retrospective study without control group.