Does exchange arthroplasty of an infected shoulder prosthesis provide better eradication rate and better functional outcome, compared to a permanent spacer or resection arthroplasty? a systematic review

Abstract

BackgroundThe best surgical modality for treating chronic periprosthetic shoulder infections has not been established, with a lack of randomised comparative studies. This systematic review compares the infection eradication rate and functional outcomes after single- or two-stage shoulder exchange arthroplasty, to permanent spacer implant or resection arthroplasty.MethodsFull-text papers and those with an abstract in English published from January 2000 to June 2014, identified through international databases, such as EMBASE and PubMed, were reviewed. Those reporting the success rate of infection eradication after a single-stage exchange, two-stage exchange, resection arthroplasty or permanent spacer implant, with a minimum follow-up of 6 months and sample size of 5 patients were included.ResultsEight original articles reporting the results after resection arthroplasty (n = 83), 6 on single-stage exchange (n = 75), 13 on two-stage exchange (n = 142) and 8 papers on permanent spacer (n = 68) were included.The average infection eradication rate was 86.7 % at a mean follow-up of 39.8 months (SD 20.8) after resection arthroplasty, 94.7 % at 46.8 months (SD 17.6) after a single-stage exchange, 90.8 % at 37.9 months (SD 12.8) after two-stage exchange, and 95.6 % at 31.0 months (SD 9.8) following a permanent spacer implant. The difference was not statistically significant (p = 0.650).Regarding functional outcome, patients treated with single-stage exchange had statistically significant better postoperative Constant scores (mean 51, SD 13) than patients undergoing a two-stage exchange (mean 44, SD 9), resection arthroplasty (mean 32, SD 7) or a permanent spacer implant (mean 31, SD 9) (p = 0.029). However, when considering studies comparing pre- and post-operative Constant scores, the difference was not statistically significant.ConclusionThis systematic review failed to demonstrate a clear difference in infection eradication and functional improvement between all four treatment modalities for established periprosthetic shoulder infection. The relatively low number of patients and the methodological limitations of the studies available point out the need for well designed multi-center trials to further assess the best treatment option of peri-prosthetic shoulder infection.

Does cemented or cementless single-stage exchange arthroplasty of chronic periprosthetic hip infections provide similar infection rates to a two-stage? A systematic review

“…In the lack of large prospective, randomised controlled comparative trials, this comprehensive systematic review and meta-analysis of observational studies was undertaken to investigate the relative efficacy, in terms of recurrence of the infection, in a single- compared to two-stage exchange arthroplasty for chronic periprosthetic hip infection. A similar review has been recently reported for periprosthetic knee and shoulder infections [ 16 , 17 ]. In addition, we aim to further analyse the infection rates after cemented and cementless single-stage exchanges, which have not been previously undertaken.…”

Periprosthetic Joint Infection of Shoulder Arthroplasties: Diagnostic and Treatment Options

“…Nelson et al [ 80 ] and Cuff et al [ 23 ] did not observe any difference in the level of eradication observed after one-stage and two-stage revisions. George et al [ 81 ] undertook a systematic search of relevant publications and found significantly better clinical outcomes after one-stage revisions (mean Constant score of 51) than after two-stage revisions (mean Constant score of 44). In the same report, treatments involving a permanent spacer achieved a mean Constant score of 31 and the sine-sine resection arthroplasty a mean Constant score of 32.…”

Komplikationen bei rheumachirurgischen Eingriffen der Schulter

“…Die relativ schlechten funktionellen Ergebnisse beim 2-zeitigen Wechsel im Vergleich zum 1-zeitigem Vorgehen versucht man in den letzten Jahren durch die Verwendung von antibiotikaimprägnierten Spacern zu verbessern, die in einzelnen Fällen auch auf Dauer belassen wurden [25]. Anhand der aktuellen Datenlage besteht keine Evidenz bezüglich einer Überlegenheit einer Methode [26]. Die operative Therapie beim Rheumapatienten unterscheidet sich hierbei nicht.…”