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Surgical management of periprosthetic shoulder infections.

Abstract：

BACKGROUND:The treatment of periprosthetic joint infection is a difficult challenge in shoulder arthroplasty. This study investigated 1-stage modular component exchange vs. 1-stage complete removal and reimplantation (CRR) vs. 2-stage revision arthroplasty for periprosthetic joint infection. METHODS:Between January 1, 2004, and December 31, 2012, 79 patients received a component exchange (n = 15), CRR (n = 45), or a 2-stage (n = 19) revision for infection. A binary logistic regression analysis was performed to determine factors presenting the greatest risk of reinfection. Complications and functional outcomes were also evaluated. RESULTS:Overall, 4 of 15 (27%) component exchanges, 2 of 45 (4%) CRRs, and 4 of 19 (21%) 2-stage procedures required a reoperation for infection with a minimum of 1 year of follow-up. The difference between the CRR group and exchange group was significant (P = .030); however, the difference between the CRR group and 2-stage group did not reach statistical significance (P = .059). No preoperative and intraoperative selection bias between the groups was found. Binary logistic regression predicted that reinfection was highest in patients whose cultures grew Staphylococcus aureus (P = .004) or coagulase-negative Staphylococcus species (P = .041) or those treated with a component exchange (P = .015). The difference between groups for noninfection-related complications was not significant (P = .703). All procedures provided improved functional outcomes and pain relief. CONCLUSION:Patients with infection caused by Staphylococcus aureus or coagulase-negative Staphylococcus species may require additional operations to treat the infection. Although effective in some cases, component exchange presents an increased risk for reinfection. A 1-stage CRR procedure had similar reinfection rates as a 2-stage procedure in our patient population.

journal_name

J Shoulder Elbow Surg

journal_title

Journal of shoulder and elbow surgery

authors

Stone GP,Clark RE,O'Brien KC,Vaccaro L,Simon P,Lorenzetti AJ,Stephens BC,Frankle MA

doi

10.1016/j.jse.2016.11.054

subject

Has Abstract

pub_date

2017-07-01 00:00:00

pages

1222-1229

issue

eissn

1058-2746

issn

1532-6500

pii

S1058-2746(16)30645-0

journal_volume

pub_type

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Surgical management of periprosthetic shoulder infections.