Diagnosis and Treatment of Infected Shoulder Arthroplasty: Current Concepts Review

Muccioli, Giulio Maria Marcheggiani; Guerra, Enrico; Sarsina, Tommaso Roberti di; Alesi, Domenico; Fratini, Stefano; Cammisa, Eugenio; Rinaldi, Vito Gaetano; Lullini, Giada; Rotini, Roberto; Zaffagnini, Stefano

doi:10.1055/s-0038-1675800

Cited by 9 publications

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References 27 publications

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“…Thus, a single-stage approach is mainly reserved to acute or subacute infections with known, low-virulent bacteria. However, these rough guidelines for using the single-stage protocol have not been reflected in previous literature reviews evaluating the outcomes of different treatments of shoulder PJI, [1][2][3][4][5][6][19][20][21] which reported good results of the single-stage protocol applied even with less restrictive indications. In fact, (1) epidemiologically shoulder PJIs are more frequently driven by indolent bacteria, (2) in the case of chronic infection, this clinical presentation is obviously more likely to be attributable to a low-virulence bacterial aetiology, (3) there are numerous reports of positive results in infection control with a single-stage protocol even in the case of high-virulent bacteria.…”

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confidence: 96%

Management of periprosthetic joint infection of shoulder arthroplasty: Single-stage versus two-stage protocols. A systematic review and meta-analysis of the literature

et al. 2022

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Background The treatment of shoulder prosthetic joint infections (PJIs) requiring removal of the prosthesis is not well defined. This article aims to systematically review and compare the results of the literature in single-stage and two-stage protocols in the treatment of shoulder PJI. Methods An in-depth search on PubMed/Scopus/Web of Science databases and cross-referencing search was carried out concerning the articles reporting detailed data on the topic. Results A total of 486 shoulder PJIs were included: 137 treated with single-stage and 349 with two-stage procedure. A similar distribution between early and not-early infections (19.1% vs 80.9%) was found between the two groups. The overall rate of success in terms of PJI eradication was significantly higher in the single-stage group (95.6% vs 85.7%, p < 0.001). The non-infection-related complications rate was 13.8% in the single-stage group and 37.6% in the two-stage group ( p < 0.001), the non-infection-related revision rate was 8% and 18.9%, respectively ( p = 0.005). Discussion The single-phase protocol showed a higher success rate in eradicating the infection and a lower complication rate. However, the low number of patients included, the low quality of the articles, the lack of data on clinical severity and bacteriological virulence suggest caution in conclusions.

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