Revision shoulder arthroplasty: Patient-reported outcomes vary according to the etiology of revision

Kim, Kelvin; Elbuluk, Ameer; Jia, Nathan; Osmani, Feroz; Levieddin, Joseph; Zuckerman, Joseph D.; Virk, Mandeep S.

doi:10.1016/j.jor.2018.08.030

Cited by 13 publications

(3 citation statements)

References 24 publications

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“…All groups of patients, on average, surpassed this threshold regardless of the estimated infection risk and the antibiotic protocol initiated. A study by Kim et al suggested that revision performed for infection resulted in inferior clinical improvement compared with revision performed for other indications 11 . Our study indicated that a standardized approach to the selection of postoperative antibiotic administration yielded similar patient-reported outcomes for patients thought to be at high risk and those thought to be at low risk for PJI, although those with obvious infectious signs and symptoms were not included.…”

Section: Discussionmentioning

confidence: 99%

Oral and IV Antibiotic Administration After Single-Stage Revision Shoulder Arthroplasty

Yao

Jurgensmeier

Whitson

et al. 2021

Journal of Bone and Joint Surgery

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Background: Following revision shoulder arthroplasty, postoperative antibiotics are selected before the results of intraoperative cultures become available. We determined infection-free survival, revision-free survival, complications, and patient-reported outcomes for patients selected to receive oral or intravenous (IV) antibiotics after revision arthroplasty.Methods: This study included 92 patients who had revision shoulder arthroplasty. IV antibiotics were administered if the surgeon had a high index of suspicion for infection, and oral antibiotics were given if there was a low suspicion. Antibiotic therapy was modified based on intraoperative culture results. Patient-reported outcomes and adverse events were documented at a mean of 4.1 years. Results:In selecting antibiotic therapy, surgeons correctly predicted the presence or absence of multiple positive cultures of specimens from the revision surgery in 72% of the 92 cases. Subsequent re-revision surgery was required in 17 (18%) of the patients; 8 of these 17 patients had ‡2 positive cultures at re-revision. Patients who initially received IV antibiotics and those who initially received oral antibiotics had similar revision-free (p = 0.202) and infection-free (p = 0.155) survivorship. Patients requiring a change from oral to IV antibiotics based on positive cultures had similar survivorship compared with those initially treated with IV antibiotics. The IV and oral antibiotic groups had similar postoperative Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES), and satisfaction scores. Patients receiving IV antibiotics had a higher rate of antibiotic-related adverse events.Conclusions: Post-revision antibiotic therapy was associated with an infection-free survival rate of 91% at a mean of >4 years of follow-up. Infection-free survival, revision-free survival, and patient-reported outcomes were similar in high-risk patients placed on IV antibiotics and low-risk patients placed on oral antibiotics. Further study is needed to define the indications for IV or oral antibiotics after revision arthroplasty.

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Section: Discussionmentioning

confidence: 99%

Oral and IV Antibiotic Administration After Single-Stage Revision Shoulder Arthroplasty

Yao

Jurgensmeier

Whitson

et al. 2021

Journal of Bone and Joint Surgery

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“…George et al 5 found average Constant scores between 31 and 51 for patients undergoing exchange arthroplasty, resection arthroplasty, or permanent spacer implant. Kim et al 6 demonstrated that revision arthroplasty for infection had the least functional improvements compared with other etiologies for revision. In our experience, we supported the patients' autonomy and opinion that in their particular cases, the treatment using staged revision or resection seemed worse than the problem itself.…”

Section: Discussionmentioning

confidence: 99%

Conservative management of chronic Cutibacterium acnes prosthetic shoulder infection: 2 case reports with minimum 6-year follow-up

2019

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“…Reverse total shoulder arthroplasty (RSA) has become increasingly popular, with an estimated 30,000 RSAs performed in the United States in 2012 15 . RSA not only has seen a substantial increase in the primary setting but also has become the procedure of choice in the revision setting, with multiple studies demonstrating improvements in patient-reported outcome measures following revision to RSA for various etiologies [16][17][18] . In our practice, revision to a reverse prosthesis is commonly considered in the setting of a loose anatomical glenoid component because of the perceived benefits of improved glenoid fixation and the ability to compensate for associated rotator cuff insufficiency or severe soft-tissue imbalance.…”

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confidence: 99%

Revision Reverse Shoulder Arthroplasty for Anatomical Glenoid Component Loosening Was Not Universally Successful

Bartels

Marigi

Sperling

et al. 2021

Journal of Bone and Joint Surgery

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Background: Glenoid component loosening is a primary cause of failure of anatomical total shoulder arthroplasty (TSA) and is commonly associated with glenoid bone loss. The purpose of the present study was to evaluate the outcome and survival following revision to a reverse total shoulder arthroplasty (RSA) for the treatment of loosening of a polyethylene cemented glenoid component in the setting of failed TSA.Methods: Between 2010 and 2017, 151 shoulders underwent revision to RSA for the treatment of loosening of an anatomical polyethylene glenoid component. Shoulders with staged reconstruction for the treatment of infection were excluded. One hundred and twenty-seven patients (67 women and 60 men) had a single-stage reconstruction and were available for follow-up. The mean age at the time of surgery was 70 years (range, 41 to 93 years). In all cases, the humeral component was revised and a standard glenoid baseplate was utilized. Bone graft was used at the discretion of the treating surgeon. Medical records and radiographs were reviewed to collect demographic, intraoperative, and postoperative data; to quantify glenoid bone loss; and to determine the radiographic outcome. The mean duration of follow-up was 35 months (range, 24 to 84 months).Results: Revision to RSA resulted in significant improvements in terms of pain and motion. Sixteen shoulders (13%) underwent revision surgery for the treatment of baseplate loosening. Radiographic baseplate loosening was present in 6 additional shoulders (overall rate of baseplate loosening, 17%). Intraoperative fracture or fragmentation of the greater tuberosity occurred in 30 shoulders (24%). Other reoperations included resection for deep infection (3 shoulders), arthroscopic biopsies for unexplained persistent pain (2 shoulders), humeral tray exchange for dislocation (2 shoulders), revision for humeral loosening (1 shoulder), irrigation and debridement for hematoma (1 shoulder), and internal fixation of periprosthetic fracture (1 shoulder) (overall reoperation rate, 20%). Among shoulders with surviving implants at the time of the most recent follow-up, pain was rated as none or mild in 83 shoulders (65.4%) and the average active elevation and external rotation were 132°and 38°, respectively. With the numbers available, no risk factors for failure could be identified.Conclusions: Revision RSA for the treatment of loosening of an anatomical polyethylene component was associated with a 17% glenoid mechanical failure rate. Although this procedure resulted in improvements in terms of pain and function, it was not universally successful and thus needs further refinement in order to improve outcomes.

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Revision shoulder arthroplasty: Patient-reported outcomes vary according to the etiology of revision

Abstract: Revision to RTSA significantly improved PRO scores compared to hemi- or total shoulder arthroplasty. RevSA for infection demonstrated the least improvement in outcomes.

Cited by 13 publications

References 24 publications

Oral and IV Antibiotic Administration After Single-Stage Revision Shoulder Arthroplasty

Oral and IV Antibiotic Administration After Single-Stage Revision Shoulder Arthroplasty

Conservative management of chronic Cutibacterium acnes prosthetic shoulder infection: 2 case reports with minimum 6-year follow-up

Revision Reverse Shoulder Arthroplasty for Anatomical Glenoid Component Loosening Was Not Universally Successful

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