Two-stage revision for infected shoulder arthroplasty

Area of Science:

• Orthopedic Surgery
• Infectious Disease Management

Background:

• Periprosthetic shoulder infections (PSIs) present significant treatment challenges and patient morbidity.
• Current management often mirrors hip/knee protocols due to lack of standardized PSI treatment.
• Two-stage revision is the established standard for hip and knee periprosthetic infections.

Purpose of the Study:

• To evaluate the efficacy of two-stage revision surgery for treating periprosthetic shoulder infections.
• To assess functional outcomes and complication rates associated with this treatment in a PSI patient cohort.

Main Methods:

• A case series and literature review of 19 patients treated with two-stage revision for PSI.
• Analysis of patient demographics, infection characteristics (including microbial cultures), and prior surgical history.
• Minimum 2-year follow-up assessing treatment success, functional scores, and complication incidence.

Main Results:

• Fifteen of 19 patients achieved successful treatment of PSI after a mean 63-month follow-up.
• Significant improvement in shoulder function, with ASES scores averaging 69 and forward elevation increasing from 58° to 119°.
• A 26% rate of recurrent infection and a 16% rate of non-infection complications were observed.

Conclusions:

• Two-stage revision is a viable option for eradicating chronic periprosthetic shoulder infections and restoring function.
• This approach is particularly relevant for intractable and chronic PSI cases.
• Awareness of potential recurrent infections and postoperative complications is crucial for managing this patient group.