Survival and Recurrence of Infection After Revision of Infected Total Elbow Arthroplasty: A French Multicenter Study (2013–2023) of 137 infected Total Elbow Arthroplasties - 11/06/26

Doi : 10.1016/j.otsr.2026.104774

Charles Louvet ^a,^b,⁎ , Christophe Chantelot ^a,^b, Philippe-Alexandre Faure ^a,^b,^f, Caroline Loiez ^c,^f, Benjamin Valentin ^d,^f, Barthélémy Lafon-Desmurs ^a,^e,^f, Eric Senneville ^a,^e,^f, Henri Migaud ^a,^b,^f, Marc Saab ^a,^b

^a Univ. Lille, Hauts de France, 59000 Lille, France

^b Service d’Orthopedie, Hopital Salengro, Place de Verdun, CHU Lille, 59000 Lille, France

^c Université Lille-Hauts de France, Service de Microbiologie du CHU de Lille 2 avenue Oscar Lambret, 59037 Lille, France

^d Université Lille-Hauts de France, Service de Pharmacie Clinique, Pharmacie, CHU de Lille, 59000 Lille, France

^e Université Lille-Hauts de France, Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing 155 rue du Président Coty, 59208 Tourcoing, France

^f Centre de Référence Pour le Traitement des Infections Ostéo-Articulaires Complexes (CRIOAC), Avenue du Professeur-Emile-Laine, 59037 Lille-Tourcoing, France

^⁎ Correponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 11 June 2026

Abstract

Introduction

Total elbow arthroplasty (TEA) has substantially grown over the last decades and has become a mainstay in the management of severe rheumatoid elbow, as well as in elderly patients with distal humerus fractures or nonunions. However, TEA infection remains a serious complication, and data—especially for France—is scarce, or limited to small case-series. Therefore, we performed a retrospective review of the French national infection registry aiming to (i) evaluate the survival of infected TEA in France between 2013 and 2023 and (ii) identify the risk factors for recurrent infections.

Material and methods

We conducted a retrospective, multicenter study using data from the national network of complex bone and joint infections (CRIOAC), including all patients with confirmed TEA infection (per 2018 MSIS criteria) assessed through multidisciplinary meetings between 2013 and 2023. Patient demographics, clinical data, microbiology, surgical revision type, and outcomes were collected. Survival for any-cause revision was assessed by Kaplan–Meier analysis; cumulative incidence of septic and aseptic revision estimated using a competing-risks model (Kalbfleisch–Prentice). Cause-specific Cox regression identified risk factors for septic recurrence. Significance threshold was set at 0.05.

Results

Among 157 patients initially identified, 137 met inclusion criteria. At 24 months, overall survival was 69.1% (95% CI:64.9 -79.9); at 120 months, 57.0% (95% CI: 46.6 - 66.7). Fifty patients (36.5%) underwent revision, including 36 (26.3%) for septic recurrence and 14 (10.2%) for aseptic causes. Cumulative incidence of septic recurrence was 20.7% at 12 months (95% CI: 14.3–27.9) and 23.3% at 24 months (95% CI: 16.5–30.9). Two factors were significantly associated with septic recurrence: longer interval between primary TEA implantation and first infection (HR 1.005 per month (p = 0.032) 95% CI: 1.0 – 1.009) and prior elbow surgery (HR 2.92 (p = 0.006) 95% CI: 1,2 – 6,1)

Conclusion

In this first French multicenter registry-based series, infected TEA display substantial risk of revision, mostly within the first two years, with notable long-term recurrence. Former elbow surgery and long delay from implantation to infection are significant risk factors.

Level of evidence

IV; retrospective cohort

Le texte complet de cet article est disponible en PDF.

Keywords : periprosthetic joint infection, prosthesis survival, suppressive antibiotic, DAIR: debridement and implant retention, one-stage or two-stage revision, Cement antibiotic spacer