Department of Orthopaedic and Trauma Surgery, "Mater Domini" University Hospital, "Magna Græcia" University, V.le Europa, (Loc. Germaneto), 88100, Catanzaro, Italy.
Department of Surgery, Division of Orthopedics and Trauma Surgery, "G. Jazzolino" Hospital, Piazza Fleming, 89900, Vibo Valentia, Italy.
Arch Orthop Trauma Surg. 2023 Feb;143(2):1117-1131. doi: 10.1007/s00402-022-04512-3. Epub 2022 Jul 1.
The aim of this systematic review was to investigate the outcomes of revision surgery after periprosthetic elbow infection (PEI).
Eighteen studies with 332 PEI that underwent revision surgery were included. Demographics, laboratory and microbiological data, types of implants, surgical techniques with complications and reoperations, eradication rates, and clinical and functional outcomes were reported.
Staphylococcus aureus was the most common microorganism (40%). Pre-operatively, the mean white blood cell count was 8400 ± 4000 per microliter; the mean C-reactive protein level was 41.6 ± 66.9 mg/dl, and the mean erythrocyte sedimentation rate was 45 ± 66.9 mm/h. The Coonrad-Morrey total elbow prosthesis represented 41.2% of the infected implant, and it also represented the most common system used for the PEI revision surgery. Two-stage revision and debridement and implant retention (DAIR) were the most common procedures performed for PEI, and, on the whole, they represented 35.7 and 32.7%, respectively. The eradication rate was 76% with 2-stage, 71% with resection arthroplasty (RA), 66.7% with 1-stage, 57.7% with DAIR, and 40% with arthrodesis (EA). DAIR showed a significantly lower eradication rate than 2-stage (P = 0.003). The mean postoperative Mayo Elbow Performance Score was significantly higher in patients who underwent DAIR, and 2-stage compared with RA (P < 0.001 for all). Postoperative flexion-extension ROM was significantly higher in patients who underwent DAIR compared with 1-stage, 2-stage, and RA (P < 0.001 for all). Moreover, 1-stage and 2-stage showed a significantly greater postoperative flexion-extension ROM compared with RA (P < 0.001 for all). Reoperations occurred in 40% of patients after EA, 33.3% after 1-stage, 26.9% after DAIR and RA, and 24.1% after 2-stage. Conversion to amputation occurred in 2.2% of patients after RA and 1% after DAIR.
Two-stage revision and DAIR are the most common procedures used to manage PEI; however, the former procedure showed a significantly higher eradication rate. Resection arthroplasty showed a high eradication rate, but postoperative lower clinical and functional outcomes limit the indications for this technique. One-stage procedure showed a limited role in the current practice of PEI treatment.
Level IV.
本系统评价旨在探讨假体周围肘感染（PEI）后翻修手术的结果。
纳入 18 项研究，共 332 例 PEI 患者接受翻修手术。报告了人口统计学、实验室和微生物学数据、植入物类型、手术技术及并发症和再手术、清除率以及临床和功能结果。
金黄色葡萄球菌是最常见的微生物（40%）。术前白细胞计数平均值为 8400±4000 个/微升；C 反应蛋白水平平均值为 41.6±66.9mg/dl，红细胞沉降率平均值为 45±66.9mm/h。Coonrad-Morrey 全肘假体占感染植入物的 41.2%，也是用于治疗 PEI 翻修手术最常见的系统。二期翻修和清创保留（DAIR）是治疗 PEI 最常见的两种方法，占比分别为 35.7%和 32.7%。二期和切除关节成形术（RA）的清除率分别为 76%和 71%，一期为 66.7%，DAIR 为 57.7%，关节融合术（EA）为 40%。与二期相比，DAIR 的清除率明显较低（P=0.003）。接受 DAIR 和二期治疗的患者术后 Mayo 肘功能评分明显高于接受 RA 治疗的患者（所有 P 值均<0.001）。与 1 期、2 期和 RA 相比，接受 DAIR 治疗的患者术后屈伸活动度明显更高（所有 P 值均<0.001）。而且，1 期和 2 期的术后屈伸活动度明显大于 RA（所有 P 值均<0.001）。40%的 EA 患者、33.3%的 1 期患者、26.9%的 DAIR 和 RA 患者、24.1%的 2 期患者需要再次手术。2 例 RA 患者和 1 例 DAIR 患者需要转为截肢。
二期翻修和 DAIR 是治疗 PEI 最常用的方法，但前者的清除率明显更高。切除关节成形术具有较高的清除率，但术后临床和功能结果较低，限制了该技术的适应证。一期手术在目前治疗 PEI 的实践中作用有限。
IV 级。
