Matthew Patrick, MD, Heather K. Vincent, PhD, Kevin W. Farmer, MD, Joseph J. King, MD, Aimee M. Struk, MEd, ATC, Thomas W. Wright, MD

Journal of Shoulder and Elbow Surgery (2019) 28, 1658–1665
PMID: 31208895 DOI: 10.1016/j.jse.2019.03.001

Summary by: Christopher Hadley, BS

Periprosthetic infection following primary shoulder arthroplasty is uncommon with reported infection rates between 1% – 5%.^1-6  Following revision shoulder arthroplasty, however, the rate increases to as high as 15%.^1-6 Traditionally, a 2-stage reimplantation procedure is performed for the management of chronically infected shoulder arthroplasties; however, outcomes following this management are limited to only a few studies.^7,8

In this study, Patrick et al. retrospectively investigated 27 patients who underwent 2-stage revision for an infected shoulder arthroplasty and 20 patients who underwent surgical treatment with an antibiotic spacer as their definitive treatment. Recurrent infection developed in 5 patients; however, there was no significant difference between those treated with an antibiotic spacer (n=3) and those who underwent 2-stage revision (n=2) (P = .25). A total of 20 procedure-related complications and 11 medical complications were observed across both groups, but no statistically significant differences between the two groups was observed for either type of complication. Patients in the 2-stage group had statistically significantly better Constant scores (58.1 vs. 33.3, P = .04) and elevation (94.4 vs. 48.6, P = .02) than patients in the antibiotic spacer group. The authors concluded that two-stage revision procedures and the use of an antibiotic spacer for definitive management of periprosthetic shoulder infections were similar, with no significant difference found between the groups in eradicating infections.

Limitations of the study include its retrospective nature and possible selection bias, due to the fact that older patients were more likely to elect treatment via articulating spacer. Although this study is one of the largest to report outcomes of treatment for infected shoulder arthroplasty, the small sample size makes the study underpowered to detect moderate differences.

References:

1. Bonnevialle N, Dauzeres F, Toulemonde J, Elia F, Laffosse J-M, Mansat P. Periprosthetic shoulder infection: an overview. EFFORT Open Rev 2017;2:104-9. https://doi.org/10.1302/2058-5241.2.160023
2. Cofield RH, Edgerton BC. Total shoulder arthroplasty: complications and revision surgery. Instr Course Lect 1990;39:449-62.
3. Coste J, Reig S, Trojani C, Berg M, Walch G, Boileau P. The management of infection in arthroplasty of the shoulder. J Bone Joint Surg Br 2004;86:65-9.
4. Schwyzer H, Simmen B, Gschwend N. [Infection following shoulder and elbow arthroplasty. Diagnosis and therapy]. Orthopade 1995;24: 367-75 [in German].
5. Singh JA, Sperling JW, Schleck C, Harmsen WS, Cofield RH. Periprosthetic infections after total shoulder arthroplasty: a 33-year perspective. J Shoulder Elbow Surg 2012;21:1534-41. https://doi.org/10.1016/j.jse.2012.01.006
6. Sperling JW, Kozak TK, Hanssen AD, Cofield RH. Infection after shoulder arthroplasty. Clin Orthop Relat Res 2001;382:206-16.
7. StoneGP, Clark RE, O’Brien KC, Vaccaro L, Simon P, Lorenzetti AJ, et al. Surgical management of periprosthetic shoulder infections. J Shoulder Elbow Surg 2017;26:1222-9. https://doi.org/10.1016/j.jse.2016.11.054
8. Cuff D, Virani N, Levy J, Frankle M, Derasari A, Hines B, et al. The treatment of deep shoulder infection and glenohumeral instability with debridement, reverse shoulder arthroplasty and postoperative antibiotics. J Bone Joint Surg Br 2008;90:336-42. https://doi.org/10.1302/0301-620X.90B3.19408