Treatment Outcomes of Periprosthetic Joint Infection After Elbow Arthroplasty: A Retrospective Cohort Study

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Introduction & Aim The incidence of total elbow arthroplasty (TEA) is increasing. Periprosthetic joint infection (PJI) is a severe complication, with a reportedly higher incidence compared to hip and knee arthroplasty. Evidence guiding treatment of elbow PJI is limited and largely based on small single-center studies, resulting in a lack of knowledge on optimal management strategies. This study aims to evaluate current treatment strategies and outcomes of elbow PJI using patient-level data from 5 specialized centers in the Netherlands. Methods We conducted a multicenter retrospective cohort study of patients with PJI following TEA, identified through the Dutch Arthroplasty Register and institutional databases. PJI was defined according to European Bone and Joint Infection Society criteria. Clinical, microbiological, and treatment-related variables were collected at both patient and registry level. We used the infection episode as the unit of analysis. Treatment strategies included DAIR, one-stage revision, two-stage revision and resection arthroplasty. Outcomes were assessed in terms of infection control and re-revision. Results A total of 80 PJI episodes in 58 patients were identified across participating centers. PJI were most often classified as chronic (59%). We observed heterogeneity in treatment choices between and within centers. DAIR was the initial treatment in acute PJI. Among episodes treated with DAIR, 55% achieved infection control after the first procedure. A further 26% underwent a second DAIR, of whom 67% subsequently achieved infection control. All other patients required revision or resection. Two-stage revision was the most frequently performed intervention in chronic PJI. Prosthesis retention was achieved in 4 of 6 one-stage and 10 of 21 two-stage revisions; 13 of 16 resection arthroplasties achieved infection control without a prosthesis. A cement spacer was not associated with improved outcome in two-stage revision. The most frequently isolated pathogens per infection episode were Staphylococcus epidermidis, Staphylococcus aureus , and Cutibacterium acnes . We found a substantial proportion of culture-negative and polymicrobial infections. Conclusion Elbow PJI is a complex clinical condition, and high-quality literature on its management is scarce. DAIR success depended strongly on infection classification: prosthesis retention was achieved in most acute but only a third of chronic infections. Careful classification according to EBJIS criteria may improve DAIR results, and chronic infection should not be regarded as an indication for DAIR. One-stage revision achieved retention in most cases and merits further evaluation. A national treatment guideline for TEA PJI may harmonize treatment and improve results.