Single-stage revision for peri-prosthetic shoulder infection

Abstract

There have been only a few small studies of patients with an infected shoulder replacement treated with a single-stage exchange procedure. We retrospectively reviewed 35 patients (19 men and 16 women) with a peri-prosthetic infection of the shoulder who were treated in this way. A total of 26 were available for clinical examination; three had died, two were lost to follow-up and four patients had undergone revision surgery. The mean follow-up time was 4.7 years (1.1 to 13.25), with an infection-free survival of 94%. The organisms most commonly isolated intra-operatively were Staphylococcus epidermidis and Propionibacterium acnes; two patients developed a recurrent infection. Three different types of prosthesis were used: a hemiarthroplasty, a hemiarthroplasty with a bipolar head and reverse prosthesis. The mean Constant-Murley score at final follow-up was 43.3 (14 to 90) for patients with a hemiarthroplasty, 56 (40 to 88) for those with a hemiarthroplasty with a bipolar head and 61 (7 to 90) for those with a reverse prosthesis. The mean hospital stay was 10.6 days (5 to 29). Single-stage exchange is a successful and practical treatment for patients with peri-prosthetic infection of the shoulder.

Patient and Procedure-specific Risk Factors for Deep Infection After Primary Shoulder Arthroplasty

“…This may be the result of improved recognition and techniques to identify this organism and highlights a changing profile of infection etiology, which may justify consideration of a change in prophylactic measures such as preoperative skin preparation techniques specific to the shoulder and antibiotic coverage. Previous studies have shown the most common causative pathogens in shoulder arthroplasties to be Gram-positive aerobic bacteria [9,16,17,19]. Singh et al [16,17] found, in their study spanning several decades, that S aureus was the most common offending organism in their single center study, with P acnes increasingly seen during the later period of their studies.…”

Prosthetic Joint Infection

“…Anaerobic bacteria, including Propionibacterium acnes, are more frequently identified in hip than in knee arthroplasty infections. However, shoulder arthroplasty infection is much more commonly caused by P. acnes than PJIs of other joint types (56,(110)(111)(112)(113)(114)(115)(116). Coagulase-negative staphylococci are more frequently identified than S. aureus in shoulder infection as well.…”

“…The midterm success rate was 94% (388) and the long-term success rate was 91% (385) in several small studies of hip arthroplasty infection. One-stage exchange for shoulder arthroplasty infection resulted in short-term infection-free survival in 94 to 100% of patients in two small series of patients (114,115). There are insufficient data on one-stage exchange in elbow arthroplasty infection.…”

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

“…Tout comme la plupart des auteurs (4,23,30,31,33,36,43,48) , nous avons identifié une majorité de Propionibacterium acnes et de Staphylocoques coagulase-négative sur les prélèvements per-opératoires. Certains auteurs rapportent de moins bons résultats sur l'infection en présence de germes résistants (24,(49)(50)(51) , de bacilles Gramm-négatif (24,52) , ou d'infection polymicrobienne (53) .…”