Risk factors associated with periprosthetic joint infection after total elbow arthroplasty.

Background: For patients undergoing total elbow arthroplasty (TEA), the present study aimed to investigate: (i) what risk factors are associated with periprosthetic elbow infection; (ii) what is the incidence of infection after TEA; and (iii) what is the acuity with which these infections present?

Methods: The Statewide Planning and Research Cooperative System database was used to identify all patients who underwent TEA between 2003 and 2012 in New York State. Admissions for prosthetic joint infection (PJI) were identified using ICD-9 (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis code 996.66. Multivariate analysis was used to determine risk factors that were independently prognostic for PJI.

Results: Significant risk factors for PJI included hypothyroidism [odds ratio (OR) = 2.04; p  = 0.045], tobacco use disorder (OR = 3.39; p  = 0.003) and rheumatoid arthritis (OR = 3.31; p  < 0.001). Among the 1452 patients in the study period who underwent TEA, 3.7% ( n  = 54) were admitted postoperatively for PJI. There were 30 (56%) early infections, 17 (31%) delayed infections and seven (13%) late infections.

Conclusions: Pre-operative optimization of thyroid function, smoking cessation and management of rheumatoid disease may be considered in surgical candidates for TEA. The results of the present study add prognostic data to the literature that may be helpful with patient selection and risk profile analysis.

Level of evidence: Level III: prognostic study.