Arthrodesis for failed total elbow arthroplasty with deep infection

Abstract

Background: Elbow arthrodesis is typically reserved as a salvage procedure. Current literature suggests that satisfactory outcomes can be expected if fusion occurs. There is a paucity of literature on outcomes of elbow arthrodesis after failed elbow arthroplasty with deep infection.

Methods: Five elbow arthrodeses were performed after a failed elbow arthroplasty due to deep infection. Clinical data were retrospectively reviewed for all surviving patients. Fusion angle, complications, and time to fusion or resection arthroplasty were recorded. The procedure was considered a failure if resection arthroplasty was required or there was a failure of bone union after 1 year.

Results: The average age at arthrodesis was 49 years (range, 35-69 years). One patient died 3 months after arthrodesis and was excluded from analysis. No patients had confirmed union at final follow-up. Two developed a fibrous union and were not symptomatic. All patients required at least 1 reoperation; 6 reoperations were required in total for the entire group. Three patients required revision arthrodesis after hardware failure. Two patients ultimately underwent a resection arthroplasty. One patient required débridement and hardware removal after wound dehiscence. Other complications included 2 patients with transient ulnar neuritis.

Conclusion: Elbow arthrodesis is not recommended as a salvage procedure for failed total elbow arthroplasty after infection because of a high reoperation rate and difficulty in achieving solid fusion.

Keywords: Total elbow arthroplasty; arthritis; arthrodesis; deep infection; joint fusion; salvage procedure.