One-stage exchange shoulder arthroplasty for peri-prosthetic infection

Abstract

There are few reports in the literature of the diagnosis and treatment of the infected shoulder arthroplasty. Most deal with resection arthroplasty and two-stage exchange surgery. We present our results of one-stage exchange operation as treatment for the infected shoulder arthroplasty. Our group comprised 16 patients (ten men, six women) with 16 infected arthroplasties. By the time of follow-up, two patients had died (mean 5.8 years), two could not be located and three had already undergone revision surgery. Nine patients were thus available for clinical examination and assessment. The infections were largely caused by staphylococci, Propionibacterium species and streptococci. Two were early infections (within three months of surgery) and 14 were late infections. The mean follow-up was 5.8 years (13 months to 13.25 years) when the mean Constant-Murley score was 33.6 points and the mean University College of Los Angeles score 18.3 points. Further revision was performed in three patients. One sustained a peri-prosthetic humeral fracture, another developed an acromial pseudarthrosis after transacromial surgery and the third suffered recurrent dislocations. No patient had a recurrence of infection. A one-stage exchange procedure using antibiotic-loaded bone cement eradicated infection in all our patients and we suggest that such a procedure is at least as successful as either a resection arthroplasty or a two-stage exchange in the management of the infected shoulder arthroplasty.

Two-stage Reimplantation for Treating Prosthetic Shoulder Infections

“…Control of infection continues to be the primary goal, and various treatment options have been reported in the literature, including long-term antibiotics, débridement with retention of prosthesis, resection arthroplasty, singlestage exchange, and delayed reimplantation [1,3,7,11,13,14]. The high rates of recurrent infection with IV antibiotics alone or débridement with retention of components (up to 65% [1,10]) have led surgeons to explore alternative treatment options, such as resection arthroplasty, which however is associated with substantial functional limitations [1,4,10].…”

“…In previous reports [3,4,7,14], expectation for postoperative function after periprosthetic shoulder joint infection always focused on quality of the rotator cuff tissues. Clearly a reverse shoulder arthroplasty provides a possible solution in this clinical setting as it relies primarily on deltoid muscle function to determine function [6].…”

“…Most reports [3,7,13,14] are retrospective and limited by small sample size, variation in surgical technique, and inclusion of multiple treating surgeons, thus restricting the conclusions that Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.…”

“…Studies evaluating resection arthroplasty and one-stage reimplantation have reported infection recurrence rates from 0% to 46% with continued pain, poor function, and low patient satisfaction rates [2,3,7,14]. Two-stage surgical protocols calling for component explantation and placement of a polymethylmethacrylate (PMMA) antibiotic-impregnated cement spacer, followed by reimplantation after a course of IV antibiotics, reportedly have a risk for recurrent infection of 38% [14].…”

Management of complications after revision shoulder arthroplasty

“…A retrospective, multicenter study found that infection was eradicated in 82 % of patients using the PROSTALAC implant, while 57 % underwent successful two-stage reimplantation [79]. Ince et al managed 16 patients with infected shoulder arthroplasties with a single-stage method and found no recurrence of infection [80]. Sperling et al treated three patients with prosthetic infection using a twostage method and found no recurrence of infection.…”