Short-term outcomes of two-stage reverse total shoulder arthroplasty with antibiotic-loaded cement spacer for shoulder infection

Abstract

Background: The purpose of our study was to investigate short-term outcomes of two-stage reverse total shoulder arthroplasty (RTSA) with an antibiotic-loaded cement spacer for shoulder infection.Methods: Eleven patients with shoulder infection were treated by two-stage RTSA following temporary antibiotic-loaded cement spacer. Of the 11 shoulders, nine had pyogenic arthritis combined with complex conditions such as recurrent infection, extensive osteomyelitis, osteoarthritis, or massive rotator cuff tear and two had periprosthetic joint infection (PJI). The mean follow-up period was 29.9 months (range, 12–48 months) after RTSA. Clinical and radiographic outcomes were evaluated using the visual analog scale (VAS) score for pain, American Shoulder and Elbow Surgeons (ASES) score, subjective shoulder value (SSV), and serial plain radiographs.Results: The mean time from antibiotic-loaded cement spacer to RTSA was 9.2 months (range, 1–35 months). All patients had no clinical and radiographic signs of recurrent infection at final follow-up. The mean final VAS score, ASES score, and SSV were significantly improved from 4.5, 38.6, and 29.1% before RTSA to 1.7, 75.1, and 75.9% at final follow-up, respectively. The mean forward flexion, abduction, external rotation, and internal rotation values were improved from 50.0o, 50.9o, 17.7o, and sacrum level before RTSA to 127.3o, 110.0o, 51.8o, and L2 level at final follow-up, respectively. Conclusions: Two-stage RTSA with antibiotic-loaded cement spacer yields satisfactory short-term clinical and radiographic outcomes. In patients with pyogenic arthritis combined with complex conditions or PJI, two-stage RTSA with an antibiotic-loaded cement spacer would be a successful approach to eradicate infection and to improve function with pain relief.

Two-Stage Exchange Arthroplasty for Periprosthetic Reverse Shoulder Arthroplasty Infection Provides Comparable Functional Outcomes to Primary Reverse Shoulder Arthroplasty

“…Firstly, this study was retrospective in design, regardless of prospective data collection. Secondly, and despite a consequent cohort, the number of finally included patients was undoubtedly small, especially for subgroup analysis, although comparable with previously reported series [3,[10][11][12], confirming the efficacy and safety of RSA. Moreover, a preoperative aspirate was never performed.…”

“…Focusing on treatment strategies, studies reporting results after two-stage revisions for PJIs are mainly retrospective case series [2,3,[10][11][12]. One of the issues around the debate between single-and two-stage revision is the risk of increasing soft tissue damage and bone loss with multiple surgeries.…”

“…Kim et al [10] recently reported functional outcomes after two-stage RSA following a temporary antibiotic-loaded cement spacer for shoulder infection in 11 patients at a mean follow-up of 29.9 months (range 12-48). The authors included different baseline conditions: extensive osteomyelitis with joint destruction, osteomyelitis with advanced degenerative osteoarthritis, massive rotator cuff tear, and PJIs.…”

“…However, two-stage revision remains the standard of care in the chronic setting. Few case series have reported acceptable functional outcomes after revision arthroplasty in the setting of PJIs, but most of the time, functional evaluation before implanting the primary replacement has not been reported [2,3,[10][11][12].…”

Return to Sports Activity After Reverse Total Shoulder Arthroplasty

“…14 Over the past decades, indications for RTSA have been expanded to proximal humeral fracture, irreparable rotator cuff tear (RCT) without glenohumeral osteoarthritis, primary osteoarthritis with glenoid bone loss and intact rotator cuff, and infections. 3 , 19 , 21 , 37 , 38 More RTSA procedures are performed globally as the indications extend to younger patients and the active elderly population. 9 , 36 , 42 Therefore, clinicians should focus not only on pain or daily activity but also on the ability to resume sports activity after RTSA because the expectation for sports activity after RTSA is increasing.…”