A CASE REPORT OF BOTH MECHANICAL AND SEPTIC  RADIAL HEAD REPLACEMENT FAILURE: SUCCESSFUL TREATMENT WITH TWO STAGE REVISION

Brioschi D¹, Flore J¹, Schettini F^1,2, Manzotti A^1,2

¹Ospedale L Sacco, Milano, Italy, ²Università degli Studi di Milano, Milano, Italy

Aim: Septic mobilization of radial head replacement is a rare option in clinical practice. We want to discuss an case of implant displacement with periprosthetic infection in an active young patient, treated with two stage revision.

 

Method: We present the clinical case of a 53-year-old male patient, left handed, with acute swelling and sinus formation at left elbow, following a radial head replacement implanted for fracture 10 years before. Implant displacement was associated with local cavitary defect of both olecranon and distal humerus of the same elbow. We performed initially a diagnostic step local aspiration and biopsy with MSSA + at cultures. Allergy test were all negative for orthopaedic aptenes. Patient was treated at the first stage with explant of the radial head prosthesis, which was macroscopically broken at neck/head junction, with massive local metallosis.

Radial head was replaced with custom cement spacer and local bone defects filled with bone substitute additioned with Gentamycin. Intraoperatory cultures were positive for S. capitis. After targeted antibiotic oral treatment for 6 weeks and washout we performed second stage procedure with implant of revision radial head replacement and local antibiotic delivery (Calcium Solphate with Gentamycin) was performed.

 

Results: X rays at 30 days shows progressive filling of bone defects and no mobilization of implant. Clinical results showed full flexionof the elbow, -20 degrees limitation of full extension, no prono-supination impairment. Follow up is still ongoing.

 

Conclusions: The treatment of a rare complication like metallosis and septic involvement in an elbow replacement is a potential disaster in terms of outcome for patient. We present a very good clinical outcome for the patient with radial head revision alone, preserving bone stock for further future treatments.