Surgical treatment of infected shoulder arthroplasty. A systematic review

Muccioli, Giulio Maria Marcheggiani; Huri, Gazi; Grassi, Alberto; Sarsina, Tommaso Roberti di; Carbone, Giuseppe; Guerra, Enrico; McFarland, Edward G.; Doral, Mahmut Nedim; Marcacci, Maurilio; Zaffagnini, Stefano

doi:10.1007/s00264-017-3399-0

Cited by 40 publications

(20 citation statements)

References 29 publications

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“…Of these, 141 studies were selected at initial screening and following full text screening 88 studies were eligible for inclusion in the final review. This consisted of four systematic reviews, 9–12 44 retrospective case series, 13–56 23 retrospective cohort studies, 57–79 12 diagnostic studies, 80…”

Section: Resultsmentioning

confidence: 99%

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Scoping review: Diagnosis and management of periprosthetic joint infection in shoulder arthroplasty

et al. 2018

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Background: The aim of this scoping review is to assess the current evidence regarding periprosthetic shoulder infection to inform development of evidence and consensus-based guidelines. Methods: A search of Medline, Embase and PubMed was performed; two authors screened the results independently for inclusion. Results: Totally 88 studies were included. Incidence of periprosthetic shoulder infection ranged from 0.7% to 7%. The most common organisms to cause periprosthetic shoulder infection were Propionibacterium acnes, Staphylococcus aureus, Staphylococcus epidermidis and coagulase-negative Staphylococcus. Male gender and younger age are the most reported risk factors. Erythrocyte sedimentation rate, C-reactive protein and serum/synovial biomarkers had limited diagnostic accuracy. Thirty-nine studies reported the outcome of surgical management of periprosthetic shoulder infection. Eradication rates vary from 54% to 100% for debridement procedures; 66-100% for permanent spacers; 50-100% following single-stage revision; 60-100% following two-stage revision; and 66-100% following resection arthroplasty. Conclusion: There is wide heterogeneity in study designs and outcomes of studies are often contradictory and due to issues with methodology and small sample sizes the optimal pathways for diagnosis and management cannot be determined from this review. Future research should be based on larger cohorts and randomised trials where feasible to provide more valid research for guiding future treatment of periprosthetic shoulder infection.

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Section: Resultsmentioning

confidence: 99%

“…Our search identified 39 studies reporting on the surgical management of PSI. This included three systematic reviews, 9–11 27 retrospective case series 13,15–19,21–24,27–31,34,35,37,42–44,47–50,53,56 and nine retrospective cohort studies 58,61,64,65,71,72,74,76,96 (see Supplementary Table 8).…”

Section: Resultsmentioning

confidence: 99%

Scoping review: Diagnosis and management of periprosthetic joint infection in shoulder arthroplasty

et al. 2018

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“…Functional outcomes as measured by CM score was also better for the one-stage revision. In a systematic review including 15 studies, Marcheggiani and colleagues reported significantly better infection control rates for one-stage revision compared to two-stage revision, with no difference between CM scores 28 . Nelson and colleagues reported higher infection control for two-stage revision; however, in their systematic review including 30 studies, the difference between the two strategies was not significant 17 .…”

Section: Discussionmentioning

confidence: 99%

One- and two-stage surgical revision of infected shoulder prostheses following arthroplasty surgery: A systematic review and meta-analysis

Kunutsor

Wylde

Beswick

et al. 2019

Sci Rep

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Periprosthetic joint infection (PJI) is a catastrophic complication of shoulder arthroplasty. Commonly used surgical treatments include one- or two-stage revision, but their effectiveness in controlling infection is uncertain. We aimed to compare re-infection (recurrent and new infections) rates; clinical measures of function and pain; and noninfection complication rates of one- and two-stage revision surgery for shoulder PJI using a systematic review and meta-analysis. We searched MEDLINE, Embase, Web of Science, and The Cochrane Library to February 2018. Longitudinal studies conducted in patients with shoulder PJI treated exclusively by one- or two-stage revision were eligible. No clinical trials were identified. Re-infection rates were meta-analysed using random-effect models after arcsine transformation. The re-infection rate (95% CI) in pooled analysis of eight one-stage studies (147 participants) was 5.3% (1.4–10.6). The corresponding rate for 27 two-stage studies (351 participants) was 11.5% (6.0–18.1). Postoperative clinical measures of function and pain were not significantly different between the two revision strategies. The pooled noninfection complication rate (95% CI) for one-stage and two-stage revision was 12.1% (6.1–19.5) and 18.9% (8.4–31.9) respectively. New evidence suggests one-stage revision is at least equally as effective as the two-stage in controlling infection, maintaining joint function, and improving complications in shoulder PJI.

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“…18 Marcheggiani Muccioli et al analyzed persistent infection rate after different surgical treatment of infected shoulder arthroplasty. 29 These results showed how debridement has significantly higher rates (29.6%) than almost any other procedure ( Fig. 1 ).…”

Section: Therapeutic Optionsmentioning

confidence: 81%

“…Permanent spacers are still a viable option as a salvage procedure for unresponsive PSIs and for low-demanding patients or patients not eligible for complex revision surgeries. 29…”

Section: Therapeutic Optionsmentioning

confidence: 99%

Diagnosis and Treatment of Infected Shoulder Arthroplasty: Current Concepts Review

Muccioli

Guerra

Sarsina

et al. 2018

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Surgical treatment of infected shoulder arthroplasty. A systematic review

Abstract: Systematic Review of level IV studies, Level IV.

Cited by 40 publications

References 29 publications

Scoping review: Diagnosis and management of periprosthetic joint infection in shoulder arthroplasty

Scoping review: Diagnosis and management of periprosthetic joint infection in shoulder arthroplasty

One- and two-stage surgical revision of infected shoulder prostheses following arthroplasty surgery: A systematic review and meta-analysis

Diagnosis and Treatment of Infected Shoulder Arthroplasty: Current Concepts Review

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