Successful Total Elbow Replacement after Septic Arthritis with Staphylococcus aureus- a Case Report and Review of the Literature.

ABSTRACT

Septic arthritis of the elbow seems to be a contraindication for total elbow arthroplasty (TEA). We here describe a 65-year-old male, American Society of Anesthesiologists (ASA) class 3 - patient, with a severely destructed right elbow due to septic arthritis with Staphylococcus aureus. His treatment consisted of multiple irrigation and debridement procedures including resection of the distal humerus, soft tissue coverage by local rotational flap and the use of a gentamicin-vancomycin loaded PMMA spacer, i.v. and oral antibiotics. After eradication of infection, a constraint cemented TEA could then successfully be performed eight months after the initial surgery and twenty-five weeks after the last debridement procedure. Twenty-one months after the TEA, the patient remained infect free and shows excellent functional results: Disabilities of the Arm, Shoulder and Hand (DASH) score 38.3, Broberg and Morrey score 91/100, Mayo elbow score 95/100. To the best of our knowledge this is the first case in the literature that demonstrates TEA after septic elbow arthritis with Staphylococcus aureus. Although TEA is known as a typical surgical procedure with a low volume in numbers and higher complication rates, such as elevated infection rates compared to other types of arthroplasty, septic arthritis with Staphylococcus aureuscan successfully be performed after eradication of the infection and targeted antibiotic therapy. Key wordstotal elbow arthroplasty, total elbow replacement, septic arthritis, Staphylococcus aureus.