LAUSR

BACKGROUND Revision Total Elbow Arthroplasty (TEA) is a challenging procedure that is becoming increasingly common. In our unit we regard it as essential to exclude infection as the underlying cause of TEA loosening. In all patients with arthroplasty loosening we undertake a careful history and examination, perform radiographs, monitor inflammatory markers and undertake a joint aspiration. If any investigation suggests infection as the etiology then a 2-stage revision is undertaken. Open biopsies are not routinely performed. The aim was to ascertain from our outcomes whether it is safe to perform a single-stage revision for presumed aseptic loosening using these criteria. METHODS A retrospective review of a consecutive series of revision TEAs was performed in our unit over a 10-year period (2008-2018). Single-stage revisions performed for presumed aseptic loosening were identified. Case notes, radiographs, bloods, aspiration results and microbiology of tissue samples taken at revision were reviewed. RESULTS A total of 123 revision elbow arthroplasty cases were performed in the study period. Sixty cases were revised for preoperatively proven infection, instability or implant failure and were excluded from this study. In 63 cases, aseptic loosening was diagnosed based on history, clinical examination, blood markers and aspiration. There were 21 dual-component and 42 single-component revisions. In the dual-component revision group, tissue samples taken at time of revision were positive in only 1 case (5%). In the single-component revision group, positive culture samples were present in 3 cases (7%). Chi-squared analysis showed no significant difference between single and dual-component revisions (p=0.76). No cases with positive culture samples from either group have required subsequent revision surgery. CONCLUSION Given the results of this study we conclude that is safe to perform single-stage revision arthroplasty for implant loosening based on history, examination, normal inflammatory markers and negative aspiration results without the need for open biopsy.