The management of infection in arthroplasty of the shoulder

Abstract

The management and outcome of treatment in 42 patients (49 shoulders) with an infected shoulder prosthesis was reviewed in a retrospective multicentre study of 2343 prostheses. The factors which were analysed included the primary diagnosis, the delay between the diagnosis of infection and treatment and the type of treatment. Treatment was considered to be successful in 30 patients (71%). Previous surgery and radiotherapy were identified as risk factors for the development of infection. All patients with an infected prosthesis had pain and limitation of movement and 88% showed radiological loosening. In 50% of the shoulders, the antibiotics chosen and the length of treatment were considered not to be optimal. The mean follow-up was 34 months. Antibiotics or debridement alone were ineffective. In acute infection, immediate revision with excision of all infected tissue and exchange of the prosthesis with appropriate antibiotic therapy gave the best results. Multidisciplinary collaboration is recommended.

Two-stage Reimplantation for Treating Prosthetic Shoulder Infections

“…Control of infection continues to be the primary goal, and various treatment options have been reported in the literature, including long-term antibiotics, débridement with retention of prosthesis, resection arthroplasty, singlestage exchange, and delayed reimplantation [1,3,7,11,13,14]. The high rates of recurrent infection with IV antibiotics alone or débridement with retention of components (up to 65% [1,10]) have led surgeons to explore alternative treatment options, such as resection arthroplasty, which however is associated with substantial functional limitations [1,4,10].…”

“…The high rates of recurrent infection with IV antibiotics alone or débridement with retention of components (up to 65% [1,10]) have led surgeons to explore alternative treatment options, such as resection arthroplasty, which however is associated with substantial functional limitations [1,4,10]. Both single-stage and two-stage exchange arthroplasty demonstrate high rates of infection control; however, the most reproducible rates of infection control have been obtained with two-stage reimplantation procedures [3,4,13,14]. Our objectives were to determine the reinfection rate for a patient cohort treated with a similar two-stage exchange arthroplasty.…”

“…Most reports [3,7,13,14] are retrospective and limited by small sample size, variation in surgical technique, and inclusion of multiple treating surgeons, thus restricting the conclusions that Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.…”

“…Studies evaluating resection arthroplasty and one-stage reimplantation have reported infection recurrence rates from 0% to 46% with continued pain, poor function, and low patient satisfaction rates [2,3,7,14]. Two-stage surgical protocols calling for component explantation and placement of a polymethylmethacrylate (PMMA) antibiotic-impregnated cement spacer, followed by reimplantation after a course of IV antibiotics, reportedly have a risk for recurrent infection of 38% [14].…”

Management of complications after revision shoulder arthroplasty

“…Antibiotic suppression alone typically has high failure rates [77]. It can be considered for severely ill patients and those unwilling to undergo further surgery.…”