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High infection control rate after systematic one-stage procedure for shoulder arthroplasty chronic infection

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Abstract

Purpose

The two stage revision procedure is the gold standard surgical technique in chronic shoulder periprosthetic joint infection (PJI). Series of one stage revision have been published with similar outcomes but with preoperative selection of patients. The aim of this work was to report the outcomes (infection eradication, functional, and radiographic) after systematic one stage revision, without preoperative selection of patients, in chronic shoulder PJI.

Methods

This was a retrospective monocentric study including 40 patients (14 women and 26 men) with a diagnosis of periprosthetic joint infection after a shoulder arthroplasty. A one stage shoulder prosthesis revision was performed in all patients, for a PJI evolving for more than three weeks, without preoperative patient selection. The primary endpoint was the absence of signs of persistent infection at a minimum follow-up of two years. Secondary endpoints were clinical and radiological outcomes.

Results

At the last follow-up, 36/40 patients had no recurrence of infection after the one stage revision, i.e., 90% of our series. In 45% (18/40) of the cases, the microbial organism was not known at the time of the one stage revision. Cutibacterium acnes was the most frequent pathogen, found in 67.5% (27/40) of the patients. The infection was polymicrobial in 40% (16/40) of the cases. At last follow-up, mean absolute Constant score was 48.4% (16–93) and weighted score was 65.5% (22–100), and satisfaction was evaluated by the patients as excellent or good in 75% (30/40). About 20% (8/40) of the patients had a postoperative complication.

Conclusion

A one stage revision procedure, combined with appropriate antibiotic therapy, made it possible to eradicate the PJI in 90% of the shoulders in our series with satisfactory functional outcomes.

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Author information

Authors and Affiliations

  1. Shoulder and Elbow Surgery Department, Hautepierre Hospital 2 - CHU Strasbourg, Avenue Molière, 67000, Strasbourg, France

    Laëla El Amiri, Philippe Clavert & Maxime Antoni

  2. Department of Orthopedic Septic Surgery, University Hospitals of Strasbourg, 1 place de l’hôpital, 67000, Strasbourg, France

    Jeannot Gaudias, Stéphane Klein & Cécile Rondé Oustau

Authors
  1. Laëla El Amiri
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  2. Philippe Clavert
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  3. Jeannot Gaudias
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  4. Stéphane Klein
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  5. Cécile Rondé Oustau
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  6. Maxime Antoni
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Laela El Amiri and Maxime Antoni. The first draft of the manuscript was written by Laela El Amiri and Maxime Antoni, and all authors commented on the previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Maxime Antoni.

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Ethics approval and consent to participate

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Faculties of Medicine, Dentistry, Pharmacy, Nursing, Physiotherapy, Maieutics, and Hospitals of Strasbourg (Reference: CE-2022-71). Informed consent was obtained from all individual participants included in the study.

Consent for publication

Informed consent to publish has been received from all participants whose X-rays appear in the manuscript.

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The authors declare no competing interests.

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El Amiri, L., Clavert, P., Gaudias, J. et al. High infection control rate after systematic one-stage procedure for shoulder arthroplasty chronic infection. International Orthopaedics (SICOT) 47, 2809–2826 (2023). https://doi.org/10.1007/s00264-023-05927-2

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