Management of the infected shoulder prosthesis: a retrospective analysis and review of the literature

Abstract

Experience with infected shoulder arthroplasty is limited. Treatment options are either one-or two-stage reimplantation, débridement with retention of the prosthesis, resection arthroplasty or arthrodesis. We retrospectively analysed ten patients with an infected shoulder prosthesis and evaluated the diagnostic and therapeutic management as well as the clinical outcome, assessed by the Constant score, Neer's criteria and the mean abduction ability. We identified an infecting organism before surgery in nine patients. Four patients were treated by two-stage exchange reimplantation, five by resection arthroplasty and one underwent serial débridement combined with vacuum-irrigation therapy. Infection was eradicated in all patients of this series. The mean Constant score in resected patients was 32.7, in patients treated by stage exchange 40.1 (no difference) and we measured 90 points in the patient with retention of the implant. In patients treated by resection arthroplasty, merely the mean abduction yielded a better result (63 vs 31°) than in patients treated by two-stage exchange-with the pain level being identical in both groups. Treatment of infected shoulder implants in patients who often have to deal with concomitant diseases remains unsatisfactory. Two-stage exchange procedures yielded only slightly better functional results than resection arthroplasty, which should be considered in cases of elderly or chronically ill patients because it offers good pain relief. Serial débridement combined with irrigation therapy is a new method which offers good clinical results, however with an unknown risk of persisting infection. The authors recommend isolating the infecting organism prior to surgery to allow the administration of organism-specific antibiotics as early as possible during surgery in order to efficiently eradicate the infection.

What treatment for periprosthetic shoulder infection? Results from a multicentre retrospective series

“…This finding is not surprising and has been previously described in periprosthetic infections after hip and knee replacement [20,21]. On the other hand, intraoperative microbiology examination, even if performed without ultrasound, nearly doubled the chances of isolating the causative micro-organism; this finding is different from that reported by Weber et al [19], which showed a 100% positive intraoperative cultural examination, but is consistent with many other studies, where only a variable percentage of all intraoperative swabs showed positive growth [3,4,6,9,10]. Our organism spectrum was similar to that reported in most other studies, with Staphylococcus and Propionibacterium spp.…”

“…Although different treatment options have been reported, a consensus about the best therapeutic strategy is still lacking [19]. To our knowledge, this is the largest continuous series of infected shoulder prosthesis ever reported.…”

“…being the most commonly isolated bacteria, both pre-and intraoperatively. In particular, Propionibacterium is an agent frequently encountered in infected shoulder arthroplasties but only rarely seen in knee or hip infections [9,10,19,22,23]. Pre-and postoperative hospital length of stay was assessed for the first time in this study and was extremely variable.…”

Complications infectieuses des prothèses totales inversées d’épaule. À propos d’une série rétrospective, multicentrique de 32 patients réopérés

“…Seul Beekman et al (30) a rapporté une série de 10 infections sur prothèse inversée, traitées par révision en 1 temps, avec 100% de guérison et un résultat fonctionnel satisfaisant. Plusieurs auteurs ont en revanche étudié les résultats de ces révisions dans les infections de prothèses d'épaule non contraintes, avec des taux de guérison allant de 63 à 100% (21,(31)(32)(33)(34)(35)(36)(37)(38) . Le résultat fonctionnel rapporté est le plus souvent meilleur qu'en pré-opératoire, mais variable selon les séries : Coste et al (21) obtient un CS moyen à 66 après révision en 1 temps, et 35 après révision en 2 temps, Jerosh et al (38) un CS à 48 sur une série comprenant une majorité de traitement en 2 temps, et récemment Klatte et al (31) un CS de 43 à 61 après traitement en 1 temps, selon le type de prothèse réimplantée (respectivement hémi ou inversée).…”

Management of Prosthetic Infection According to Organism

“…Other microorganisms such as enterococci, streptococci, corynebacterium, fungal species and mycobacterial species are reported less commonly [3,27]. Of note, the microbiology of prosthetic joint infection differs between upper limb and lower limb arthroplasty: Propionibacterium acnes is one of the most common microorganisms encountered in shoulder prosthetic joint infection, occurring in up to 40% of shoulder arthroplasty infections [16,28,29]. This association may be due to the increased occurrence of Propionibacterium acnes around the head and neck, in particular in the sebaceous glands and hair bulbs [12].…”