Arthroscopic Management of Septic Arthritis of the Native Shoulder: A Systematic Review

Memon, Muzammil; Kay, Jeffrey; Ginsberg, Lydia; de, Darren; Simunovic, Nicole; Samuelsson, Kristian; Athwal, George S.; Ayeni, Olufemi R.

doi:10.1016/j.arthro.2017.07.038

Cited by 28 publications

(40 citation statements)

References 31 publications

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“…The estimated overall prevalence of septic arthritis is 12 cases per 100.000 inhabitants per year. Around 3 to 21% of the cases affect the shoulder, which is the third most common site, and is most prevalent in patients over 60 years old [2][3][4][5]8,10,[14][15][16][17] . Bilateral occurrence in the shoulder is exceedingly rare, and we have found only one case reported in the medical literature.…”

Section: Discussionmentioning

confidence: 99%

“…Septic arthritis is an emergency due to its potential to cause rapid destruction of cartilage and bone as well as the risk for systemic spread 1,2 . The most common affected sites are hip and knee, which account for approximately 61 to 79% of cases; the shoulder is the third most affected site representing about 3 to 15% of the total number of sites 2,5 .…”

Section: Introductionmentioning

confidence: 99%

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Bilateral septic arthritis of the shoulder: case report and literature review

Maia¹,

Silva²,

Santos³

et al. 2021

Arch Health Invest

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Bilateral shoulder septic arthritis is a rare condition in immunocompetent patients without known risk factors, therefore, it can be easily misdiagnosed. Septic arthritis is an emergency due to its potential to cause rapid destruction of cartilage and bone as well as the risk for systemic spread. Aggressive early treatment is crucial for easing pain, preventing joint collapse, and permanent loss of shoulder function. We presented a case report of a 68 years-old man, suffering from multiple comorbidities and bilateral shoulder septic arthritis. The patient underwent arthroscopic surgery in the left shoulder. Antibiotic therapy was carried out after the surgical procedure using clindamycin. The patient had a satisfactory outcome, characterized by regression of the inflammatory symptoms in both shoulders. There was an improvement in pain and fevers settled. In this case report, we have also discussed treatment options as well as possible outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bilateral septic arthritis of the shoulder: case report and literature review

Maia¹,

Silva²,

Santos³

et al. 2021

Arch Health Invest

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“…Early treatment is therefore mandatory to alleviate pain and restore optimal function. Open or arthroscopic irrigation and debridement associated with targeted intravenous antibiotic therapy is effective to eradicate the infection[1,18,19]. While arthroscopic procedure seems to lead to better forward flexion and less persistent postoperative pain than open surgery[1,7,20], the number of required procedures is higher and increases further with the severity of infection[21-23].…”

Section: Discussionmentioning

confidence: 99%

“…The shoulder represents the third most common location for septic arthritis in adults[1]. Primary management consists of arthroscopic or open irrigation and debridement and is usually combined with local and systemic antibiotherapy to eradicate the infection.…”

Section: Introductionmentioning

confidence: 99%

“…When dealing however with a degenerative joint with advanced osteoarthritis, irreparable or massive rotator cuff tears or in presence of endocutaneous fistulas, this classic approach is burdened by a higher failure rate with insufficient eradication of the infection and unsatisfactory functional outcomes. A recent review on shoulder septic arthritis from 2018 reported a 28% revision rate (mean age of 63.9 years), and a 21% complication rate (mean age of 63.7 years) after primary debridement[1]. In the recent years, several authors reported promising results using a two-stage approach to arthroplasty in infected osteoarthritic knees[8,9].…”

Section: Introductionmentioning

confidence: 99%

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Advanced septic arthritis of the shoulder treated by a two-stage arthroplasty

Goetti¹,

Gallusser²,

Antoniadis³

et al. 2019

WJO

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BACKGROUNDThe usual treatment of septic shoulder arthritis consists of arthroscopic or open lavage and debridement. However, in patients with advanced osteoarthritic changes and/or massive rotator cuff tendon tears, infection eradication can be challenging to achieve and the functional outcome is often not satisfying even after successful infection eradication. In such cases a two-stage approach with initial resection of the native infected articular surfaces, implantation of a cement spacer before final treatment with a total shoulder arthroplasty in a second stage is gaining popularity in recent years with the data in literature however being still limited.AIMTo evaluate the results of a short interval two-stage arthroplasty approach for septic arthritis with concomitant advanced degenerative changes of the shoulder joint.METHODSWe retrospectively included five consecutive patients over a five-year period and evaluated the therapeutic management and the clinical outcome assessed by disability of the arm, shoulder and hand (DASH) score and subjective shoulder value (SSV). All procedures were performed through a deltopectoral approach and consisted in a debridement and synovectomy, articular surface resection and insertion of a custom made antibiotic enriched cement spacer. Shoulder arthroplasty was performed in a second stage.RESULTSMean age was 61 years (range, 47-70 years). Four patients had previous surgeries ahead of the septic arthritis. All patients had a surgical debridement ahead of the index procedure. Mean follow-up was 13 mo (range, 6-24 mo). Persistent microbiological infection was confirmed in all five cases at the time of the first stage of the procedure. The shoulder arthroplasties were performed 6 to 12 wk after insertion of the antibiotic-loaded spacer. There were two hemi and three reverse shoulder arthroplasties. Infection was successfully eradicated in all patients. The clinical outcome was satisfactory with a mean DASH score and SSV of 18.4 points and 70% respectively.CONCLUSIONShort interval two-stage approach for septic shoulder arthritis is an effective treatment option. It should nonetheless be reserved for selected patients with advanced disease in which lavage and debridement have failed.

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