Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
J Hand Surg Am. 2020 Oct;45(10):957-970. doi: 10.1016/j.jhsa.2020.05.020. Epub 2020 Aug 1.
Periprosthetic joint infection (PJI) is a potentially devastating complication after total elbow arthroplasty (TEA) that can lead to significant morbidity for the patient as well as increased health care-related costs. Despite the potential morbidity associated with TEA PJI, evidence is limited regarding an optimal treatment algorithm. Initial management typically consists of either irrigation and debridement or 2-stage revision. A stable implant, a functioning triceps, and an intact soft tissue envelope are necessary to perform irrigation and debridement. Irrigation and debridement is associated with a relatively high risk of infection recurrence especially in chronic infections. Two-stage revision offers a lower recurrence risk, although there is a 25% chance of not completing the second stage. Resection arthroplasty, arthrodesis, and amputation are salvage options, whereas medical treatment, in the form of antibiotics alone, is reserved for poor surgical candidates. Further multicenter prospective study and retrospective review of registry data focusing on different treatment algorithms, prevention strategies, and functional outcomes would be helpful to elucidate the ideal management of elbow PJI.
人工肘关节置换术后假体周围关节感染（PJI）是一种潜在的灾难性并发症，可导致患者出现严重的发病率，并增加与医疗保健相关的成本。尽管 TEA PJI 存在潜在的发病率，但关于最佳治疗方案的证据有限。初始治疗通常包括灌洗和清创术或 2 期翻修。要进行灌洗和清创术，需要有稳定的植入物、功能正常的三头肌和完整的软组织包膜。灌洗和清创术与感染复发的风险相对较高相关，尤其是在慢性感染中。2 期翻修可降低复发风险，但有 25%的可能性无法完成第 2 期。切除关节成形术、关节融合术和截肢术是挽救性选择，而单独使用抗生素的药物治疗则保留给手术效果不佳的患者。进一步的多中心前瞻性研究和对注册数据的回顾性审查，重点关注不同的治疗方案、预防策略和功能结果，将有助于阐明肘关节 PJI 的理想治疗方法。
