One-stage revision for patients with a chronically infected reverse total shoulder replacement

Abstract

We retrospectively reviewed 11 consecutive patients with an infected reverse shoulder prosthesis. Patients were assessed clinically and radiologically, and standard laboratory tests were carried out. Peroperative samples showed Propionbacterium acnes in seven, coagulase-negative Staphylococcus in five, methicillin-resistant staphylococcus aureus in one and Escherichia coli in one. Two multibacterial and nine monobacterial infections were seen. Post-operatively, patients were treated with intravenous cefazolin for at least three days and in all antibiotic therapy was given for at least three months. Severe pain (3 of 11) or severe limitation of function (3 of 11) are not necessarily seen. A fistula was present in eight, but function was not affected. All but one patient were considered free of infection after one-stage revision at a median follow-up of 24 months, and without antibiotic treatment for a minimum of six months. One patient had a persistent infection despite a second staged revision, but is now free of infection with a spacer. Complications included posterior dislocation in one, haematoma in one and a clavicular fracture in one. At the most recent follow-up the median post-operative Constant-Murley score was 55, 6% adjusted for age, gender and dominance. A one-stage revision arthroplasty reduces the cost and duration of treatment. It is reliable in eradicating infection and good functional outcomes can be achieved.

Does Reverse Shoulder Arthroplasty for Tumors of the Proximal Humerus Reduce Impairment?

“…The patient with an early infection was treated with open débridement and antibiotics for 6 months. Two years later, he developed septic loosening (Propionibacterium acnes), which was treated with a onestage revision of the prosthesis [3] and 6 months of oral antibiotics. At latest followup (65 months after the revision surgery), this patient had a Constant-Murley score of 84, a VAS score for pain of 0, an ADLER score of 28, and an active abduction of 180°.…”

“…Early dislocations can easily be treated with closed reduction under general anesthesia and an abduction pillow in the first weeks postoperatively [7,17]. The rate of infection in RSA is reportedly at least twice as high as in hemiarthroplasty [3]. We were able to treat this complication with one-stage revision, thorough synovectomy, and long-term antibiotics, whereas the literature still advocates two-stage revision using a spacer impregnated with antibiotics.…”

Management of complications after reverse shoulder arthroplasty

“…Stage 2 involves prosthesis reimplantation, after confirmation of elimination of the infection, often done by image-guided aspiration of the glenohumeral joint. Beekman et al [22] reported successful one-stage revision to limit the amount of anesthesia and the morbidity of a second procedure to the patient. Zavala et al [20] reported successful treatment of infected RTSA with a combination debridement, liner/glenosphere exchange, and IV antibiotics regardless of chronicity of the infection.…”

“…Zavala et al [20] reported successful treatment of infected RTSA with a combination debridement, liner/glenosphere exchange, and IV antibiotics regardless of chronicity of the infection. Traditional staged resection arthroplasty can lead to significant bone and soft tissue loss and should be reserved for persistent infections or significant bone stock loss unsuitable for reimplantation [20,22]. Utilization of an open biopsy prior to the reimplantation stage may be beneficial; Zhang et al [23] reported 22 % of patients (4 out of 18 patients) with periprosthetic infection still had positive cultures during the open biopsy procedure even after a formal irrigation and debridement (I&D), implant resection, antibiotic spacer, and a course of antibiotics.…”

Indications for reverse shoulder replacement

“…5,17,22,[71][72][73][74][75][76] Revision was performed for failed treatment of proximal humeral fractures in patients with severe pain and loss of function. All patients treated in this way also had one or more of the following: tuberosity reabsorption, radiolucency around the humeral stem, osteoarthritis of the glenoid or a rotator cuff tear of > 2 cm.…”