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Surgical treatment of infected shoulder arthroplasty. A systematic review

  • Review Article
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Abstract

Purpose

To investigate the best surgical management of infected shoulder arthroplasty.

Methods

A literature review from 1996 to 2016 identified 15 level IV studies that met inclusion criteria. Persistent infection (PI) was considered as treatment failure. Success was regarded as the absence of symptomatic PI without necessity for further treatment. Surgical outcomes were reported according to the mean weighted Constant and Murley score (CMS) for each treatment group.

Results

Overall, 287 patients (146 males/141 females) were identified at a mean follow-up of 50.4 (range 32–99.6) months. The PI in the whole population was 11.5%. The pooled mean CMS, available for 218 patients, was 39 ± 13. Twenty-seven patients (9.4%) were treated with debridement (PI 29.6%, CMS 41 ± 12), 52 patients (18.1%) with resection arthroplasty (PI 11.5%, CMS 29 ± 16), 33 patients (11.5%) with permanent spacers (PI 6.1%, CMS 31 ± 14), 98 patients (34.2%) with two-stage revisions (PI 14.3%, CMS 42 ± 12) and 77 patients (26.8%) with one-stage revisions (PI 3.9%, CMS 49 ± 11).

Debridement showed the highest PI rate (29.6%) and one-stage revisions reported the lowest PI rate (3.9%). Resection arthroplasty and spacers showed the poorest CMS when compared to the other procedures (p ≤ 0.0001). The debridement PI rate was significantly higher than almost any other procedure. CMS was significantly higher in patients undergoing revision compared to non-revision procedures (45 ± 12 vs. 35 ± 14) (p < 0.0001). One-stage revisions achieved significantly better results in terms of the PI rate compared to two-stage revisions (p = 0.0223), but not in terms of CMS.

Conclusion

Debridement showed the highest PI rate (29.6%) and should not be recommended for the management of infected shoulder arthroplasty. Revisions reported better functional outcomes compared to non-revision procedures. The presence of a significantly lower PI rate with comparablely high mean CMS values suggests that one-stage (where technically applicable) could be superior to two-stage revisions.

Unfortunately, well-designed randomized controlled trials using validated patient-based outcomes are lacking in this field.

Level of evidence: Systematic Review of level IV studies, Level IV

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Authors and Affiliations

  1. Dipartimento Rizzoli Sicilia, Istituto Ortopedico Rizzoli, University of Bologna, via di Barbiano, 1/10 – c/o Lab Biomeccanica ed Innovazione Tecnologica, 40136, Bologna, Italy

    Giulio Maria Marcheggiani Muccioli, Alberto Grassi & Stefano Zaffagnini

  2. Department of Sports Medicine, University of Hacettepe, Ankara, Turkey

    Gazi Huri & Mahmut N. Doral

  3. II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy

    Tommaso Roberti di Sarsina, Giuseppe Carbone & Maurilio Marcacci

  4. Division of Shoulder Surgery, Istituto Ortopedico Rizzoli, Bologna, Italy

    Enrico Guerra

  5. Division of Shoulder Surgery, The Johns Hopkins University, Baltimore, MD, USA

    Edward G. McFarland

Authors
  1. Giulio Maria Marcheggiani Muccioli
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  2. Gazi Huri
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  3. Alberto Grassi
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  4. Tommaso Roberti di Sarsina
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  5. Giuseppe Carbone
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  8. Mahmut N. Doral
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  9. Maurilio Marcacci
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  10. Stefano Zaffagnini
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Correspondence to Giulio Maria Marcheggiani Muccioli.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

The investigation was performed at Istituto Ortopedico Rizzoli – University of Bologna – Italy.

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Marcheggiani Muccioli, G., Huri, G., Grassi, A. et al. Surgical treatment of infected shoulder arthroplasty. A systematic review. International Orthopaedics (SICOT) 41, 823–830 (2017). https://doi.org/10.1007/s00264-017-3399-0

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  • DOI: https://doi.org/10.1007/s00264-017-3399-0

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