Long-Term Outcome of Resection Arthroplasty for the Failed Total Elbow Arthroplasty

Abstract

Elbow resection is a salvage procedure typically considered as a last resort in the case of refractory infection following total elbow arthroplasty. The goal of this study was to evaluate the long-term outcome of patients following resection arthroplasty for the treatment of a failed total elbow replacement. Between 1975 and 2005, fifty-one consecutive elbows (fifty patients) were treated with resection for a deep infection following total elbow arthroplasty with either linked or unlinked implants. The average age at the time of arthroplasty was fifty-two years, and the average age at the time of elbow resection arthroplasty was fifty-nine years. Twenty-nine patients (thirty elbows) were contacted at an average of eleven years (range, 2.7 to twenty-eight years) postoperatively, and their outcomes were graded with use of the Mayo Elbow Performance Score and the Disabilities of the Arm, Shoulder and Hand (DASH) score. The remaining twenty patients (twenty-one elbows) had either died (sixteen elbows) or declined follow-up (five elbows) and so were included only in the analysis of complications and early outcome. Elbow resection resulted in an improvement in the Mayo Elbow Performance Score, from a preoperative value of 37 points to a final follow-up value of 60 points (a poor to fair result) for the twenty-nine patients contacted at long term (p < 0.05). Most of the increase in the Mayo Elbow Performance Score resulted from improvements in the pain component of the score. Of the thirty elbows in patients who had been followed long term, eight had good results; eleven, fair results; and eleven, poor results. The DASH score averaged 71 points (range, 51 to 91 points). Complications were common and included infections in twenty-four elbows (47%), intraoperative fractures in eighteen (35%), and permanent nerve injury in nine elbows (18%). Stability after resection correlated with a better long-term Mayo Elbow Performance Score (p < 0.05). Resection arthroplasty is a salvage option in patients with refractory infection after a total elbow arthroplasty and should be considered only when all other attempts to eradicate the infection have failed.