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Published on: December 3, 2017
The management of infected shoulder arthroplasty by two-stage revision
Matthew Brown1, Kelechi Eseonu1, Will Rudge1
1Department of Shoulder & Elbow Surgery, Royal National Orthopaedic Hospital, Stanmore, UK.
Background:
There remains no gold standard management for deep shoulder periprosthetic joint infection (PJI). This case series aims to present our experience of two-stage revision arthroplasty, including eradication of infection and reoperation rates.
Methods:
We retrospectively reviewed patients undergoing revision arthroplasty for shoulder PJI between 2006 and 2015. Cases were confirmed using Musculoskeletal Infection Society (MSIS) and American Academy of Orthopaedic Surgeons (AAOS) guidelines. TSA removal, debridement and irrigation preceded antibiotic-loaded cement spacer insertion and a minimum of six weeks intravenous antibiotics. Reimplantation was performed as a second stage following a negative aspirate.
Results:
Twenty-eight patients underwent a first stage procedure (mean age 69 years; 16 male, 12 female). Propionibacterium acnes, Methicillin-sensitive Staphylococcus aureus, Coagulase-negative Staphylococcus and Staphylococcus epidermidis were the commonest microorganisms cultured. Five cases had mixed growths and six cases provided no growth. Three patients did not proceed to a second stage. Twenty-five patients underwent reimplantation (mean interval 6.7 months), with 80% remaining infection-free (mean follow-up 38.3 months).
Discussion:
Managing complex and late presentation shoulder PJI with two-stage revision is associated with high rates of infection eradication (80%). In the absence of a management consensus, our experience supports two-stage revision arthroplasty for eradicating infection in this complex patient group.
Insights
Two-stage revision arthroplasty effectively treats deep shoulder periprosthetic joint infection (PJI), achieving an 80% infection-free rate. This approach offers a viable solution for complex cases lacking a management consensus.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Biomedical Engineering
Background:
- Deep shoulder periprosthetic joint infection (PJI) lacks a definitive management protocol.
- Two-stage revision arthroplasty is explored as a treatment option.
Purpose of the Study:
- To evaluate the efficacy of two-stage revision arthroplasty for shoulder PJI.
- To determine infection eradication and reoperation rates in shoulder PJI management.
Main Methods:
- Retrospective review of patients undergoing revision arthroplasty for shoulder PJI (2006-2015).
- Infection confirmation via MSIS and AAOS guidelines.
- Two-stage procedure: TSA removal, debridement, antibiotic-loaded cement spacer, IV antibiotics, followed by reimplantation after negative aspiration.
Main Results:
- 28 patients underwent the first stage; 25 proceeded to reimplantation.
- Common pathogens included P. acnes, MSSA, CoNS, and S. epidermidis.
- 80% of patients remained infection-free at a mean follow-up of 38.3 months.
Conclusions:
- Two-stage revision arthroplasty demonstrates high infection eradication rates (80%) for shoulder PJI.
- This method is a supported treatment option for complex shoulder PJI cases.
- Supports two-stage revision arthroplasty in the absence of a management consensus.
