Diagnosis and Management of Periprosthetic Joint Infection After Shoulder Arthroplasty

Cooper, Maxwell E.; Trivedi, Nikunj N.; Sivasundaram, Lakshmanan; Karns, Michael R.; Voos, James E.; Gillespie, Robert J.

doi:10.2106/jbjs.rvw.18.00152

Cited by 36 publications

(22 citation statements)

References 111 publications

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“…Treatment strategy depends on infection timing: within 30 days after surgery, a surgical debridement with polyethylene exchange (and glenosphere in RSA) may be appropriate [ 14 ]. In cases of hematogenous infection 30 days or more after surgery, implant removal with tissues debridement, one-stage or two-stage procedure (followed by species-directed antibiotic administration), should be considered [ 10 , 14 , 15 ]. Finally, in chronic infections in less serious cases or in patients who are ineligible for revision, surgical debridement with implant removal, antibiotic spacer placement, or simple resection arthroplasty would be the treatment of choice.…”

Section: Introductionmentioning

confidence: 99%

An Evolution of Shoulder Periprosthetic Infections Management: MicroDTTect, Bioactive Glass and Tantalum Cones Employment

Romano

Ascione

Casillo³

et al. 2020

JCM

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Periprosthetic joint infections of the shoulder (PJIS) are the major cause for revision within the first two post-operative years, and are challenging both to diagnose and treat. Success depends on early identification of microorganisms, appropriate surgical procedures and efficient antibiotic administration. The peculiar microbiology of the shoulder may render the criteria for hip/knee PJI management inappropriate. In addition, later cases with clinically subtle signs often present diagnostic challenges. In recent years, specific issues of PJIS have been managed through the use of new instruments, such as MicroDTTect in pathogen detection and Bioactive Glass and tantalum cones in humeral bone loss. In the literature to date, no reports have been found that discuss the application in shoulder revisions and infections. The early identification of the microorganisms that cause infection may help improve both treatment strategies and the efficacy of therapy. MicroDTTect proved to be more efficient than swab collection for bacterial identification in orthopedic surgery, thus reducing analysis costs. The increasing number of shoulder arthroplasties is associated with an increase in the number of revisions. In cases of massive metaphyseal humeral bone loss, several techniques have been described; no reports have been reported regarding tantalum in humeral bone loss management. In some cases the tantalum cones required adaptation for femoral diaphysis in the augmentation of the humerus metaphysis and bone loss management improvement. Obtaining stable osseointegration of prosthetic implants is one of the greatest issues in orthopedic surgery, and even more crucial in revisions. Bioactive glasses demonstrated good regenerative and osseointegration properties, and an excellent candidate as a bone graft, scaffold and antibiotics deliverer. The Bioactive glasses were used to increase prosthesis-bone interface stability and fill bone defects in PJIS revision surgeries, contributing to the prevention of re-infection. Longer-term follow-up will be necessary to determine if construction durability is improved in the long term.

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Section: Introductionmentioning

confidence: 99%

An Evolution of Shoulder Periprosthetic Infections Management: MicroDTTect, Bioactive Glass and Tantalum Cones Employment

Romano

Ascione

Casillo³

et al. 2020

JCM

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“…Risk factors for decreased clinical outcomes include male sex, young age, obesity, diabetes mellitus, active smoking, rheumatoid arthritis, or revision surgery. 3,13,17,20,21,31,34 Periprosthetic joint infections may occur to 1.1%-3.8%, 6 with higher numbers in septic revision cases. Theoretically, a postinfectious native shoulder might also be considered as a risk factor for new or recurrent infection after RTSA.…”

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confidence: 99%

Limited improvement and high rate of complication in patients undergoing reverse total shoulder arthroplasty for previous native shoulder infection

Kriechling

Bouaicha

Andronic

et al. 2021

Journal of Shoulder and Elbow Surgery

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Background: The outcomes of reverse total shoulder arthroplasty (RTSA) surgery for the sequelae of former septic native joint shoulder arthritis are unknown but might be inferior to patients without prior bacterial arthritis. Methods: We performed a single-center case-control study embedded in our prospective RTSA cohort. We matched all patients with prior infections in a 1:1 ratio with patients who underwent RTSA for other indications. The matching variables were indication for surgery, age, sex, dominant/nondominant shoulder, and body mass index. We evaluated outcomes by Constant score and active function. Results: Among 1249 patients in the RTSA cohort, 14 were operated for sequelae of previous native shoulder joint infections. Although both groups significantly improved from preoperative to postoperative values, the outcome of postinfectious patients was clearly inferior in comparison with the control group (absolute [38 AE 17 vs. 75 AE 8, P < .01], relative Constant score [47 AE 19 vs. 88 AE 9, P < .01], Constant pain score [11.0 AE 3.1 vs. 14.3 AE 1.3, P < .01], subjective shoulder value [43 AE 26 vs. 85 AE 10, P < .01], abduction [70 AE 43 vs. 148 AE 29 , P ¼ .001], and elevation [82 AE 49 to 131 AE 16 , P ¼ .02]). Moreover, in the postinfectious group, overall surgical complications occurred in 36%, with the need for revision in 21%. There was, however, no recurrence of infection in any of the patients' shoulders. Conclusion: RTSA for end-stage postinfectious joint disease is associated with a high number of complications and reoperations. Clinical outcomes are inferior to those without past infection.

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“…1 Shoulder PJI frequently presents nonspecifically with shoulder pain but should be suspected in cases of postoperative stiffness and osteolysis. 2 Evaluation of potential shoulder PJI is difficult, owing to the indolent nature of many such infections. Normal inflammatory markers, negative cultures after shoulder aspiration, and normal radiographic findings despite existence of infection are commonly encountered.…”

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confidence: 99%

“…4 The most frequently isolated organisms have been Cutibacterium acnes, Staphylococcus epidermidis, and Staphylococcus aureus. 2 Treatment goals for shoulder PJI include eradication of the infection, decreased pain, and increased function.…”

mentioning

confidence: 99%

“…Two-stage revision is a common treatment strategy for patients with shoulder PJI due to the relatively low infection recurrence rates (0%-36%), pain relief, and improvement in shoulder function. 2 This technique typically involves initial shoulder irrigation and debridement, hardware removal, and placement of a humeral antibiotic cement spacer in conjunction with oral or intravenous antibiotics. Once the PJI has been eradicated, the humeral antibiotic cement spacer can be revised and an arthroplasty prosthesis (hemiarthroplasty, anatomic total shoulder arthroplasty, or reverse total shoulder arthroplasty) can be placed.…”

mentioning

confidence: 99%

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Creation of a Custom-Length, Humeral Antibiotic Cement Spacer for Use in Treatment of Shoulder Periprosthetic Joint Infection

Klosterman

Cotter

Squire

et al. 2021

Arthroscopy Techniques

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Periprosthetic joint infection of the shoulder is a challenging clinical situation to manage owing to the fastidious organisms often present and delayed clinical presentation. While several treatment options have been described, the mainstay of treatment remains a staged revision with the use of a humeral antibiotic cement spacer. Such spacers are commercially available or can be made by hand. When an extended humeral osteotomy is required to remove a well-fixed long stem humeral component, it may be advantageous to place an antibiotic spacer with a stem length approximately as long as the hardware being removed. This technique demonstrates creation of a custom length, humeral antibiotic cement spacer for use in treatment of shoulder periprosthetic joint infection.

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Diagnosis and Management of Periprosthetic Joint Infection After Shoulder Arthroplasty

Cited by 36 publications

References 111 publications

An Evolution of Shoulder Periprosthetic Infections Management: MicroDTTect, Bioactive Glass and Tantalum Cones Employment

An Evolution of Shoulder Periprosthetic Infections Management: MicroDTTect, Bioactive Glass and Tantalum Cones Employment

Limited improvement and high rate of complication in patients undergoing reverse total shoulder arthroplasty for previous native shoulder infection

Creation of a Custom-Length, Humeral Antibiotic Cement Spacer for Use in Treatment of Shoulder Periprosthetic Joint Infection

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