Analysis of infection in shoulder arthroplasty: a multicentre study

Amaravathi, Rajkumar S.; Kany, Jean; Melet, Myriam; Katz, Denis; Sauzières, P.; Valenti, Philippe; Gandois, Jean Marc

doi:10.1007/s00590-011-0806-x

Cited by 20 publications

(17 citation statements)

References 22 publications

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“…Our search identified 12 primary studies and two systematic reviews 10,11 reporting the outcome in patients undergoing irrigation and debridement procedures. The primary research included five retrospective case series 13,15,23,42,53 and seven retrospective cohort studies. 58,61,64,65,[71][72][73] The success rate for treating acute infection using debridement and implant retention (DAIR) procedures ranged from 54% 64 to 100%.…”

Section: Surgical Management Of Psimentioning

confidence: 99%

Scoping review: Diagnosis and management of periprosthetic joint infection in shoulder arthroplasty

et al. 2018

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Background: The aim of this scoping review is to assess the current evidence regarding periprosthetic shoulder infection to inform development of evidence and consensus-based guidelines. Methods: A search of Medline, Embase and PubMed was performed; two authors screened the results independently for inclusion. Results: Totally 88 studies were included. Incidence of periprosthetic shoulder infection ranged from 0.7% to 7%. The most common organisms to cause periprosthetic shoulder infection were Propionibacterium acnes, Staphylococcus aureus, Staphylococcus epidermidis and coagulase-negative Staphylococcus. Male gender and younger age are the most reported risk factors. Erythrocyte sedimentation rate, C-reactive protein and serum/synovial biomarkers had limited diagnostic accuracy. Thirty-nine studies reported the outcome of surgical management of periprosthetic shoulder infection. Eradication rates vary from 54% to 100% for debridement procedures; 66-100% for permanent spacers; 50-100% following single-stage revision; 60-100% following two-stage revision; and 66-100% following resection arthroplasty. Conclusion: There is wide heterogeneity in study designs and outcomes of studies are often contradictory and due to issues with methodology and small sample sizes the optimal pathways for diagnosis and management cannot be determined from this review. Future research should be based on larger cohorts and randomised trials where feasible to provide more valid research for guiding future treatment of periprosthetic shoulder infection.

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Section: Surgical Management Of Psimentioning

confidence: 99%

Scoping review: Diagnosis and management of periprosthetic joint infection in shoulder arthroplasty

et al. 2018

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“…With regards to infection control, the evidence has been inconsistent for one-stage revision. Whiles some series have reported good infection control 9,13 , a high risk of infection recurrence has also been reported 14 . Emerging data suggests that one- and two-stage revision strategies for hip and knee PJI are comparable in terms of infection control 15,16 .…”

Section: Introductionmentioning

confidence: 99%

One- and two-stage surgical revision of infected shoulder prostheses following arthroplasty surgery: A systematic review and meta-analysis

Kunutsor

Wylde

Beswick

et al. 2019

Sci Rep

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Periprosthetic joint infection (PJI) is a catastrophic complication of shoulder arthroplasty. Commonly used surgical treatments include one- or two-stage revision, but their effectiveness in controlling infection is uncertain. We aimed to compare re-infection (recurrent and new infections) rates; clinical measures of function and pain; and noninfection complication rates of one- and two-stage revision surgery for shoulder PJI using a systematic review and meta-analysis. We searched MEDLINE, Embase, Web of Science, and The Cochrane Library to February 2018. Longitudinal studies conducted in patients with shoulder PJI treated exclusively by one- or two-stage revision were eligible. No clinical trials were identified. Re-infection rates were meta-analysed using random-effect models after arcsine transformation. The re-infection rate (95% CI) in pooled analysis of eight one-stage studies (147 participants) was 5.3% (1.4–10.6). The corresponding rate for 27 two-stage studies (351 participants) was 11.5% (6.0–18.1). Postoperative clinical measures of function and pain were not significantly different between the two revision strategies. The pooled noninfection complication rate (95% CI) for one-stage and two-stage revision was 12.1% (6.1–19.5) and 18.9% (8.4–31.9) respectively. New evidence suggests one-stage revision is at least equally as effective as the two-stage in controlling infection, maintaining joint function, and improving complications in shoulder PJI.

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“…[5–7] Infection is a devastating complication requiring revision surgery, with reported rates between 0% and 4% in primary shoulder arthroplasties. [5–8] The diagnosis of infection is often classified as high (acute) or low grade (chronic). It is based on a combination of symptoms, laboratory tests, findings in physical and radiological examinations, and confirmed by positive intraoperative cultures.…”

Section: Discussionmentioning

confidence: 99%

“…It is based on a combination of symptoms, laboratory tests, findings in physical and radiological examinations, and confirmed by positive intraoperative cultures. [1489] While high-grade infections are easily recognizable from clinical signs, chronic or low-grade infection can be a serious diagnostic challenge[4] In these cases, most of the pre-operative investigations prove not to be extremely useful and positive culture rates can be as high as 25% in presumably uninfected shoulders during revision arthroplasty. [1679]…”

Section: Discussionmentioning

confidence: 99%

Septic failure is not a septic loosening: A case report of a failed shoulder prosthesis

Engelsma¹,

Buma²,

Geervliet³

et al. 2012

Int J Shoulder Surg

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Septic failure of a shoulder arthroplasty due to a low-grade infection is generally called septic loosening. However, it is often not investigated if a prosthesis is genuinely loose. We present a case of a failed resurfacing prosthesis in a 70-year-old woman. This prosthesis failed due to a low-grade infection and a revision procedure was mandatory. All intraoperative cultures were positive and revealed a combination of bacteria. Nevertheless, histology revealed a macroscopic and a microscopic stable prosthesis with full osseointegration beneath the prosthesis. The general conception is that an infection leads to interface formation (with neutrophils) and loosening of the prosthesis. We debate this with the presentation of this case of a failed shoulder prosthesis and we think that periprosthetic infection and septic prosthetic loosening are two different entities.

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Analysis of infection in shoulder arthroplasty: a multicentre study

Cited by 20 publications

References 22 publications

Scoping review: Diagnosis and management of periprosthetic joint infection in shoulder arthroplasty

Scoping review: Diagnosis and management of periprosthetic joint infection in shoulder arthroplasty

One- and two-stage surgical revision of infected shoulder prostheses following arthroplasty surgery: A systematic review and meta-analysis

Septic failure is not a septic loosening: A case report of a failed shoulder prosthesis

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