Abstract

GALLUCCI, Gerardo et al. Artroplastia total de codo después de un proceso infeccioso. Cirugía en dos tiempos. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2021, vol.86, n.2, pp.185-196. ISSN 1852-7434.  http://dx.doi.org/https://doi.org/10.15417/issn.1852-7434.2021.86.2.1160.

Objective: To report the results of patients with an infectious elbow process, treated in 2 surgical stages: the first with an antibiotic cement spacer (ACS) and the second with a total elbow arthroplasty. Materials and Methods: The inclusion criteria, the diagnosis of infection and the 2 surgical stages are described. Results: 10 patients were included (7 men and 3 women), average age: 62 years old. Initial causes: degenerative in 2 cases and traumatic in 8. 4 alloprostheses and 2 latissimus dorsi flaps were performed.

Follow-up was 5 years. Flexo-extension was 117°/29° in preoperative and 130°/29° in postoperative; pain according to VAS: 6.5 and 2.5; MEPS: 40 and 80; DASH 56 and 30 respectively. The extension strength was M5 (4 cases), M4 (2), M3 (1), M1 (2) and M0 (1). One patient presented a necrosis of the flap that evolved with infection. In 9 of the 10 cases the patients were free of infection at the end of the follow-up. Two groups of patients were identified: Group A (bone defects less than 4 cm) and B (more than 4 cm). Group A patients had fewer previous surgeries and better functional outcomes. Conclusion: The treatment of an infectious elbow process through the placement of antibiotic cement spacer, allows a control of the infection in a high percentage of cases. Secondary prosthetic reconstruction is demanding and associated with complications. It is to be expected that the greater the bone defect and the greater the number of previous procedures, the worse the functional results.

Keywords : Total elbow arthroplasty; infection; osteomyelitis; antibiotic spacer.

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