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Permanent Spacers Are a Reliable Solution for Peri-prosthetic Shoulder Infection: A Systematic Review.

Mattia Alessio-Mazzola1,2, Ilaria Repetto1,2, Antonio Russo1,2

  • 1Department of Surgical Sciences and Integrated Diagnostic (DISC), University of Genoa, Viale Benedetto XV, 6, 2° piano, 16132 Genoa, Italy.

HSS Journal : the Musculoskeletal Journal of Hospital for Special Surgery
|October 21, 2020
PubMed
Summary

Permanent cement spacers offer a reliable solution for treating shoulder arthroplasty infections in older patients, achieving high infection eradication rates and moderate functional outcomes. Further high-quality research is needed to confirm their definitive role.

Keywords:
articular shoulder spacerinfectionperi-prosthetic infectionshoulderspacer

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Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Biomaterials Science

Background:

  • Peri-prosthetic shoulder infection (PSI) is a severe complication of shoulder arthroplasty, often necessitating complex surgical interventions and extended antibiotic treatments.
  • The efficacy of antibiotic-loaded cement spacers, particularly as a definitive treatment for PSI, remains a subject of ongoing debate within the medical community.

Purpose of the Study:

  • To systematically review existing literature on the use of antibiotic-loaded cement spacers as a definitive treatment for PSI.
  • To evaluate infection eradication rates, mechanical reliability, and functional outcomes associated with permanent cement spacer use in PSI management.

Main Methods:

  • A systematic literature review was conducted, adhering to Cochrane Handbook and PRISMA guidelines, covering studies published from January 1, 1980, to September 1, 2019.
  • Searched eight databases and reference lists for studies reporting outcomes of PSI treated with permanent shoulder spacers.
  • Two independent reviewers applied exclusion criteria and extracted data on functional and clinical results.

Main Results:

  • Twelve studies involving 143 patients were included, with a mean age of 65.8 years and a mean follow-up of 37.4 months.
  • A high infection eradication rate of 93% (133 out of 143 patients) was observed at the latest follow-up.
  • Moderate functional outcomes were reported, with mean active elevation ranging from 48.6° to 90°, abduction from 51° to 75°, external rotation from 3.6° to 29°, and Constant-Murley scores from 20.6 to 42.

Conclusions:

  • Permanent cement spacers represent a reliable treatment option for PSI in elderly, low-demand patients with comorbidities, offering an alternative to further surgery.
  • The review indicates a high success rate in eradicating infection and achieving acceptable functional results, though the overall evidence quality is low.
  • Higher-quality studies are required to definitively establish the role of permanent spacers in the comprehensive management of peri-prosthetic shoulder infections.