Staged exchange arthroplasty for shoulder sepsis

Eight patients with shoulder sepsis were treated with staged exchange arthroplasty using antibiotic-impregnated polymethyl methacrylate spacers shaped and fitted to the patient's anatomy after extensive joint débridement. Intravenous antibiotic therapy followed for a minimum of 3 months. At the end of 6 months, the patients were evaluated for any clinical or laboratory signs of infection; none were encountered. Exchange prosthetic reconstructions were performed using standard implants fixed with antibiotic-impregnated polymethyl methacrylate cement. Three patients underwent a revision to total shoulder arthroplasty, whereas 5 underwent hemiarthroplasty of the humerus with local capsular flap covering of the glenoid. All patients experienced substantial pain relief and improvement in function despite limited total overhead motion, showing this technique to be a satisfactory salvage procedure for managing sepsis of the glenohumeral joint primarily and after total shoulder arthroplasty.