Abstract
Abstract
Background
Prosthetic joint infection (PJI) is a challenging complication of total elbow replacement (TER). Potential surgical treatments include one- or two-stage revision; however, the best treatment for elbow PJI is not clearly defined. We conducted a systematic review in accordance with PRISMA guidelines to compare the clinical effectiveness of one- and two-stage revision surgery for elbow PJI using re-infection (recurrent and new infections) rates; mortality; clinical measures of function, pain, and satisfaction; and non-infection related adverse events.
Methods
MEDLINE, Embase, Web of Science, and The Cochrane Library were searched up to June 2019 to identify observational cohort studies and randomised controlled trials (RCTs) that had recruited patients with elbow PJI following TER and treated with one- or two-stage revision. Of 96 retrieved articles, 2 one-stage and 6 two-stage revision studies were eligible. No RCT was identified. Arcsine transformation was used in estimating rates with 95% confidence intervals (CIs).
Results
Staphylococcus aureus was the most common causative organism for PJI of the elbow (24 of 71 elbow PJIs). The re-infection rate (95% CI) for one-stage (7 elbows) ranged from 0.0% (0.0–79.3) to 16.7% (3.0–56.4) and that for two-stage revision (87 elbows) from 0.0% (0.0–49.0) to 20.0% (3.6–62.4). Non-infection related adverse event rate for one-stage (based on a single study) was 16.7% (3.0–56.4) and that for two-stage ranged from 11.8% (4.7–26.6) to 20.0% (3.6–62.4). There were no mortality events recorded following one- or two-stage revision surgery and postoperative clinical measures of function, pain, and satisfaction could not be effectively compared because of limited data.
Conclusions
No strong conclusions can be drawn because of limited data. The one-stage revision may be potentially at least as clinically effective as two-stage revision, but further data is needed. There are clear gaps in the existing literature and studies are urgently warranted to assess the clinical effectiveness of one- and two-stage revision strategies for PJI following TER.
Systematic review registration
PROSPERO 2018: CRD42018118002.
Funder
National Institute for Health Research
NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol
Publisher
Springer Science and Business Media LLC
Subject
Orthopedics and Sports Medicine,Rheumatology
Reference32 articles.
1. Krenek L, Farng E, Zingmond D, SooHoo NF. Complication and revision rates following total elbow arthroplasty. J Hand Surg Am. 2011;36(1):68–73.
2. National Joint Registry for England and Wales: 15th Annual Report. 2018. Accessed from
http://www.njrreports.org.uk/Portals/0/PDFdownloads/NJR%2015th%20Annual%20Report%202018.pdf
.
3. Little CP, Graham AJ, Carr AJ. Total elbow arthroplasty: a systematic review of the literature in the English language until the end of 2003. J Bone Joint Surg Br. 2005;87(4):437–44.
4. Morrey BF, Bryan RS. Infection after total elbow arthroplasty. J Bone Joint Surg Am. 1983;65(3):330–8.
5. Park SE, Kim JY, Cho SW, Rhee SK, Kwon SY. Complications and revision rate compared by type of total elbow arthroplasty. J Shoulder Elb Surg. 2013;22(8):1121–7.
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