Staged Revision With Antibiotic Spacers for Shoulder Prosthetic Joint Infections Yields High Infection Control

Grubhofer, Florian; Imam, Mohamed A.; Wieser, Karl; Achermann, Yvonne; Meyer, Dominik C.; Gerber, Christian

doi:10.1007/s11999.0000000000000049

Cited by 39 publications

(22 citation statements)

References 30 publications

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“…12 However, Grubhofer et al appreciated comparable success rates between single and staged revisions even in cases of unknown infectious etiology. 14 Tseng et al developed a 3-stage shoulder revision protocol to address persistent infections. 15 The first stage included implant explantation, tissue cultures, debridement, cement removal, cement spacer insertion, and intravenous (IV) antibiotic treatment.…”

Section: Infectionmentioning

confidence: 99%

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Management of Revision Reverse Shoulder Arthroplasty

Goldman

Halpern

Deal

et al. 2020

Journal of Shoulder and Elbow Arthroplasty

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Background: The number of reverse total shoulder arthroplasty procedures performed has increased in recent years due to expanding surgical indications. There has been a proportional increase in complications, with reported complication rates for a revision reverse total shoulder arthroplasty as high as 68%. Revising a reverse total shoulder is a complex procedure requiring significant preoperative planning. Methods: A literature review of revision shoulder arthroplasty techniques was performed. No IRB approval was needed for this study. Results: Instability is the most common reason for revision reverse total shoulder arthroplasty followed by infection. Revision arthroplasty is also needed in the setting of bone loss, aseptic loosening, and periprosthetic fracture. Each case requires a comprehensive preoperative plan to address each deformity for a successful result. Conclusions: For this procedure to be successful, it is imperative that the physician understands the risk factors, identifies the cause, and is familiar with current surgical techniques. This study reviews both preoperative and perioperative management of reverse total shoulder arthroplasty in the revision setting.

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Section: Infectionmentioning

confidence: 99%

“…appreciated comparable success rates between single and staged revisions even in cases of unknown infectious etiology. 14…”

Section: Complicationsmentioning

confidence: 99%

Management of Revision Reverse Shoulder Arthroplasty

Goldman

Halpern

Deal

et al. 2020

Journal of Shoulder and Elbow Arthroplasty

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“…Currently, two‐stage revision is considered as the “gold standard” for chronic PJI treatment 7 , which requires removal of the prosthesis and implantation of an antibiotic‐impregnated spacer. The implantation of antibiotic‐impregnated spacers plays an important role in two‐stage revision, as it can: (i) release antibiotics directly into joint to control the infection locally; (ii) simultaneously maintain the joint space and reduce soft tissue contracture to facilitate reimplantation of the prosthesis; and (iii) maintain joint stability, which provides basic joint functions to meet the needs of daily life 8–10 . In clinical practice, some patients cannot tolerate reoperation after spacer implantation because of complicated underlying diseases, while some patients are satisfied with joint function after spacer implantation, so they refuse reimplantation of the prostheses 3 .…”

Section: Introductionmentioning

confidence: 99%

Destination Joint Spacers: A Similar Infection‐Relief Rate But Higher Complication Rate Compared with Two‐Stage Revision

Cai

Fang

Huang

et al. 2021

Orthopaedic Surgery

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Objective To evaluated the clinical outcomes of periprosthetic joint infection (PJI) patients with destination joint spacer compared with that of two‐stage revision. Methods From January 2006 to December 2017, data of PJI patients who underwent implantation with antibiotic‐impregnated cement spacers in our center due to chronic PJI were collected retrospectively. The diagnosis of PJI was based on the American Society for Musculoskeletal Infection (MSIS) criteria for PJI. One of the following must be met for diagnosis of PJI: a sinus tract communicating with the prosthesis; a pathogenis isolated by culture from two separate tissue or fluid samples obtained from the affected prosthetic joint; four of the following six criteria exist: (i) elevated ESR and CRP; (ii) elevate dsynovial fluid white blood cell (WBC) count; (iii) elevated synovial fluid neutrophil percentage (PMN%); (iv) presence of purulence in the affected joint; (v) isolation of a microorganism in one periprosthetic tissue or fluid culture; (vi) more than five neutrophilsper high‐power fields in five high‐power fields observed from histological analysis of periprosthetic tissue at ×400 magnification. Age, sex, body mass index (BMI), and laboratory test results were recorded. All patients were followed up regularly after surgery, the infection‐relief rates were recorded, Harris hip score (HHS) and knee society score (KSS) were used for functional evaluation, a Doppler ultrasonography of the lower limb veins was performed for complication evaluation. The infection‐relief rates and complications were compared between destination joint spacer group and two‐stage revision group. Results A total of 62 patients who were diagnosed with chronic PJI were enrolled, with an age of 65.13 ± 9.94 (39–88) years. There were 21 cases in the destination joint spacer group and 41 cases in the temporary spacer group, namely, two‐stage revision group (reimplantation of prosthesis after infection relief). The Charlson comorbidity index (CCI) in the destination joint spacer group was higher than that in the temporary spacer group, and this might be the primary reason for joint spacer retainment. As for infection‐relief rate, there were three cases of recurrent infection (14.29%) in the destination joint spacer group and four cases of recurrent infection (9.76%) in the two‐stage revision group, there were no significant differences with regard to infection‐relief rate. Moreover, there two patients who suffered from spacer fractures, three cases of dislocation, one case of a periarticular fracture, and three cases of deep venous thrombosis in destination joint spacer group, while there was only one case of periprosthetic hip joint fracture, one case of dislocation, and one patient suffered from deep venous thrombosis of the lower extremity in two‐stage revision. The incidence of complications in the destination joint spacer group was higher than that of two‐stage revision. Conclusions In summary, the present work showed that a destination joint spacer might be provided as a las...

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“…In two-stage revision surgery, the implantation of antibiotic-impregnated spacers can 1) release antibiotics to control the infection locally; 2) simultaneously maintain the joint space and reduce soft tissue contracture to facilitate reimplantation of the prosthesis; and 3) maintain joint stability, which provides basic joint functions to meet the needs of daily life [10][11][12] . In clinical practice, some patients cannot tolerate reoperation after spacer implantation because of complicated underlying diseases, while some patients are satis ed with joint function after spacer implantation, so they refuse reimplantation of the prosthesis 3 .…”

Section: Introductionmentioning

confidence: 99%

Compared with Two-Stage Revision, Destination Joint Spacers Have a Similar Infection-Relief Rate and a Higher Complication Rate

Cai¹,

Fang²,

Lin³

et al. 2020

Preprint

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Background: Two-stage revision is regarded as the “gold standard” for periprosthetic joint infection (PJI) treatment, in which antibiotic-impregnated spacers play an important role. However, some patients are unable to undergo reimplantation of the prosthesis after spacer implantation. The clinical outcomes of these patients remain unknown. The purpose of this research was to study the infection-relief rate and clinical outcome of these patients.Methods: From January 2006 to December 2017, data from PJI patients who underwent implantation with antibiotic-impregnated cement spacers in our center due to chronic PJI were collected retrospectively. Age, sex, body mass index (BMI) and laboratory test results were recorded, and the infection-relief rate and clinical outcomes were observed.Results: A total of 62 patients who were diagnosed with PJI were enrolled, with an age of 65.13 ±9.94 (39-88) years. There were 21 cases in the destination joint spacer group and 41 cases in the temporary spacer group (reimplantation of prosthesis after infection relief). The Charlson comorbidity index (CCI) in the destination joint spacer group was higher than that in the temporary spacer group. Our study showed that the infection-relief rate of destination joint spacers was similar to that of two-stage revision, but the incidence of complications was higher than that of two-stage revision, especially for the type I spacer used in this study.Conclusions: The infection-relief rate of destination joint spacers was similar to that of two-stage revision, but the complication rate was higher than that of two-stage revision (especially for the type I spacer).

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Staged Revision With Antibiotic Spacers for Shoulder Prosthetic Joint Infections Yields High Infection Control

Abstract: Level III, therapeutic study.

Cited by 39 publications

References 30 publications

Management of Revision Reverse Shoulder Arthroplasty

Management of Revision Reverse Shoulder Arthroplasty

Destination Joint Spacers: A Similar Infection‐Relief Rate But Higher Complication Rate Compared with Two‐Stage Revision

Compared with Two-Stage Revision, Destination Joint Spacers Have a Similar Infection-Relief Rate and a Higher Complication Rate

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