Arthroscopy of total elbow arthroplasty

Painful total elbow arthroplasty is not an uncommon problem. Differentiation of infection from aseptic loosening is a critical factor in directing the treatment algorithm. However, obtaining a correct microbiological and mechanical diagnosis can be difficult.

Elbow arthroscopy can be used to diagnose infection or mechanical issues of the total elbow arthroplasty.

Elbow arthroscopy allows observation of the synovitis, granulation tissue, and the articulation. In the case of elbow arthroplasty, this includes the bearings and polyethylene. Also, the bone/cement/prosthesis interfaces can also be observed. The joint can be mobilized to see if the articulation is functioning in an appropriate way. The joint can be gently stressed, to assess how the bearings behave and determine if the prosthesis interfaces are loose.

Multiple targeted tissue biopsies are harvested under arthroscopic vision and sent for microbiology and histology. Two weeks following the procedure, the bacterial diagnosis will be known. If there is a painful aseptic loosening, then a one-stage prosthesis can be performed. If there is an infection, then the bacterial type and sensitives will be known, and then an informed decision can be made in consultation with the microbiologist. In the older patient, this may include suppressive antibiotics. In the younger patient, either a one or two-stage revision arthroplasty may be recommended.