BESS PJI Guidelines - 15

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Rangan et al.

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CS. Management of infection about total elbow prostheses. J Bone Joint Surg Am 1990; 72: 198-212.
Jeon I-H, Morrey BF, Anakwenze OA and Tran NV.
Incidence and implications of early postoperative
wound complications after total elbow arthroplasty.
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857-65. 10.1016/j.jse.2011.03.005. http://search.ebscohost.com/login.aspx?direct¼true&db¼cmedm&AN¼
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after total elbow arthroplasty. J Bone Joint Surg Am
1998; 80: 481-91.
Achermann Y, Vogt M, Spormann C, et al. Characteristics
and outcome of 27 elbow periprosthetic joint infections:
results from a 14-year cohort study of 358 elbow prostheses. Clinical Microbiology and Infection 2011; 17:
432-8. 10.1111/j.1469-0691.2010.03243.x. http://dx.doi.
org/10.1111/j.1469-0691.2010.03243.x.
Spormann C, Achermann Y, Simmen BR, et al.
Treatment strategies for periprosthetic infections after
primary elbow arthroplasty. J Shoulder Elbow Surg
2012; 21: 992-1000. 10.1016/j.jse.2011.10.007.
Peach CA, Nicoletti S, Lawrence TM and Stanley D.
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total elbow arthroplasty. Bone Joint J 2013; 95-b:
1681-6. 10.1302/0301-620x.95b12.31336.
Rhee YG, Cho NS, Park JG and Song JH. Resection
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1341-6.

S15
available and following discussion with an infection specialist.
6. For DAIR, pathogen-speciﬁc antibiotics should be
continued for between three and six months.
7. For revision arthroplasty:
a DAIR is usually only considered in patients presenting with a stable implant within six weeks of
surgery and in those patients who have had
symptoms and signs of infection for only up to
three weeks unless patient factors and co-morbidities preclude major complex revision surgery.
b One stage revision is only considered when the
organism is known and of low virulence or where
patient factors preclude a two-stage procedure
c In two stage arthroplasty antibiotics are given for
a minimum of six weeks followed by a fallow
period of at least two weeks before repeat testing
or second stage.
8. Centre has access to vascular surgery, plastic surgery and infectious disease services.
9. Specialist rehabilitation services are available for
revision arthroplasty patients.
10. Length of stay is prospectively recorded.
11. Readmission rates within 30 days are prospectively
recorded.
12. Mortality rates within 365 days are prospectively
recorded.
13. PROMS are prospectively recorded pre-revision and
at a minimum of six months post procedure.
14. Revision data is entered in to the National Joint
Registry.
15. Data are prospectively recorded on recurrent infection, complications, further revision prosthetic
procedures and other adverse events.

Appendix 2: Diagnostic and procedure
codes and HRG mapping
Appendix 1: Auditable recommendations
for treatment of Periprosthetic Joint
Infection in the Shoulder and Elbow in
secondary care
1. Documented evidence of shared decision making
for treatment tailored to the patient's wishes.
2. Documented evidence of MDT discussion with an
infection specialist.
3. Intraoperative tissue ampling for infection includes
a minimum of ﬁve tissue biopsies using separate
scalpel, forceps and pots plus a further two samples
for histology.
4. Samples should be cultured for a minimum of
eight days.
5. Broad spectrum antibiotics are rationalised as soon
as possible after microbiology sensitivities are

ICD 10 Diagnostic codes**
Osteoarthritis of elbow and shoulder
M19.0 Primary arthrosis of other joints
M19.1 Post-traumatic arthrosis of other joints
M19.2 Other secondary arthrosis
Rheumatoid arthritis of the elbow and shoulder
M05 Seropositive rheumatoid arthritis
M06.0 Seronegative rheumatoid arthritis
M06.1 Adult-onset Still disease
M06.4 Inﬂammatory polyarthropathy
M08.0 Juvenile rheumatoid arthritis
For the ICD codes above you will need to add a site
code as a ﬁfth character.
For the elbow the site code is .2 - Upper arm Includes
humerus and elbow.
The site code for shoulder is .1 Shoulder region Includes
clavicle, scapula, acromioclavicular, glenohumeral, sternoclavicular joint

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Table of Contents for the Digital Edition of BESS PJI Guidelines