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Treatment strategies for infection after reverse shoulder arthroplasty

  • Reinhold Ortmaier
  • Herbert Resch
  • Wolfgang Hitzl
  • Michael Mayer
  • Ottokar Stundner
  • Mark Tauber
Original Article

Abstract

Introduction

Infection after reverse shoulder arthroplasty (RSA) is a disastrous complication. No clear guidelines describing specific management strategies for infection after RSA are available.

Methods

We retrospectively analyzed 20 patients treated for deep infection after RSA. Initial irrigation and debridement and exchange of the polyethylene inlay were performed in seven patients, and initial two-stage revision was performed in 12 and initial resection arthroplasty in one patient. Patient charts were reviewed for risk factors, clinical symptoms and investigations of those symptoms, pre- and postoperative X-rays, interval until revision surgery, causative bacteria, complications, final clinical outcome and patient satisfaction.

Results

The mean overall postoperative Constant–Murley Score (CMS) was 42.6 points, the mean UCLA score was 20.8, the mean simple shoulder test (SST) was 5.5, and the mean VAS was 1.5. When comparing the CMS, UCLA score and the SST between the revision RSA group and the resection group, significant differences between the groups were found (p < 0.05). Irrigation, debridement and exchange of the polyethylene inlay were successful only in two of the four patients with acute infection. The three patients with subacute infections were treated with initial irrigation and debridement and exchange of the polyethylene inlay, which were not successful.

Conclusion

The relatively high patient satisfaction can be explained by the low pain level once the patient is free from infection. However, functional results are poor in most cases, and this possible outcome must be discussed with the patient in the preoperative setting.

Keywords

Reverse shoulder arthroplasty Infection Two-stage revision Resection arthroplasty Irrigation and debridement Prolonged spacer Glenoid bone grafting 

Notes

Conflict of interest

The authors have not received any financial payments or other benefits from any commercial entity related to the subject of this article. There is no conflict of interest.

References

  1. 1.
    Grammont PM, Baulot E (1993) Delta shoulder prosthesis for rotator cuff rupture. Orthopedics 16:65–68PubMedGoogle Scholar
  2. 2.
    Sirveaux F, Favard L, Oudet D, Huquet D, Walch G, Molé D (2004) Grammont inverted total shoulder arthroplasty in the treatment of glenohumeral osteoarthritis with massive rupture of the cuff. Results of a multicentre study of 80 shoulders. J Bone Joint Surg Br 86:388–395PubMedCrossRefGoogle Scholar
  3. 3.
    Boileau P, Watkinson D, Hatzidakis AM, Hovorka I (2006) Neer Award 2005: the Grammont reverse shoulder prosthesis: results in cuff tear arthritis, fracture sequelae, and revision arthroplasty. J Shoulder Elbow Surg 15:527–540PubMedCrossRefGoogle Scholar
  4. 4.
    Wall B, Nové-Josserand L, O’Connor DP, Edwards TB, Walch G (2007) Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am 89:1476–1485PubMedCrossRefGoogle Scholar
  5. 5.
    Holcomb JO, Hebert DJ, Mighell MA, Dunning PE, Pupello DR, Pliner MD, Frankle MA (2010) Reverse shoulder arthroplasty in patients with rheumatoid arthritis. J Shoulder Elbow Surg 19:1076–1084PubMedCrossRefGoogle Scholar
  6. 6.
    Cheung E, Willis M, Walker M, Clark R, Frankle MA (2011) Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg 19:439–449PubMedGoogle Scholar
  7. 7.
    Zumstein MA, Pinedo M, Old J, Boileau P (2011) Problems, complications, reoperations, revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 20:146–157PubMedCrossRefGoogle Scholar
  8. 8.
    Beekman PDA, Katusic D, Berghs BM, Karelse A, De Wilde L (2010) One-stage revision for patients with a chronically infected reverse total shoulder replacement. J Bone Joint Surg Br 92:817–822PubMedCrossRefGoogle Scholar
  9. 9.
    Zavala JA, Clark JC, Kissenberth MJ, Tolan SJ, Hawkins RJ (2012) Management of deep infection after reverse total shoulder arthroplasty: a case series. J Shoulder Elbow Surg 21:1310–1315PubMedCrossRefGoogle Scholar
  10. 10.
    Amaravathi Rajkumar S, Kany Jean, Melet Myriam, Katz Denis, Sauzieres Philippe, Valenti Philippe, Gandois Jean Marc (2012) Analysis of infection in shoulder arthroplasty: a multicentre study. Eur J Orthop Surg Traumatol 22:145–150CrossRefGoogle Scholar
  11. 11.
    Sabesan VJ, Ho JC, Kovacevic D, Iannotti JP (2011) Two-stage reimplantation for treating prosthetic shoulder infections. Clin Orthop Relat Res 469:2538–2543PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Stine IA, Lee B, Zalavras CG, Hatch G 3rd, Itamura JM (2010) Management of chronic shoulder infections utilizing a fixed articulating antibiotic-loaded spacer. J Shoulder Elbow Surg 19:739–748PubMedCrossRefGoogle Scholar
  13. 13.
    Muh SJ, Streit JJ, Lenarz CJ, McCrum C, Wanner JP, Shishani Y, Moraga C, Nowinski RJ, Edwards TB, Warner JJP et al (2012) Resection arthroplasty for failed shoulder arthroplasty. J Shoulder Elbow Surg 22:247–252PubMedCrossRefGoogle Scholar
  14. 14.
    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164PubMedGoogle Scholar
  15. 15.
    Amstutz HC, Sew Hoy AL, Clarke IC (1981) UCLA anatomic total shoulder arthroplasty. Clin Orthop Relat Res (155):7–20Google Scholar
  16. 16.
    Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG, Iannotti JP, Mow VC, Sidles JA, Zuckerman JD (1994) A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg 3:347–352PubMedCrossRefGoogle Scholar
  17. 17.
    Huskisson EC (1974) Measurement of pain. Lancet 2:1127–1131PubMedCrossRefGoogle Scholar
  18. 18.
    Sperling JW, Cofield RH, O’Driscoll SW, Torchia ME, Rowland CM (2000) Radiographic assessment of ingrowth total shoulder arthroplasty. J Shoulder Elbow Surg 9:507–513PubMedCrossRefGoogle Scholar
  19. 19.
    Sperling JW, Kozak TK, Hanssen AD, Cofield RH (2001) Infection after shoulder arthroplasty. Clin Orthop Relat Res 382:206–216PubMedCrossRefGoogle Scholar
  20. 20.
    Favard L, Levigne C, Nerot C, Gerber C, De Wilde L, Mole D (2011) Reverse prostheses in arthropathies with cuff tear: are survivorship and function maintained over time? Clin Orthop Relat Res 469:2469–2475PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Stechel A, Fuhrmann U, Irlenbusch L, Rott O, Irlenbusch U (2010) Reversed shoulder arthroplasty in cuff tear arthritis, fracture sequelae, and revision arthroplasty. Acta Orthop 81:367–3721PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Trappey GJ 4th, O’Connor DP, Edwards TB (2011) What are the instability and infection rates after reverse shoulder arthroplasty? Clin Orthop Relat Res 469:2505–2511PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Wirth MA, Rockwood CA Jr (1996) Complications of total shoulder-replacement arthroplasty. J Bone Joint Surg Am 78:603–616PubMedGoogle Scholar
  24. 24.
    Patel A, Calfee RP, Plante M, Fischer SA, Green A (2009) Propionibacterium acnes colonization of the human shoulder. J Shoulder Elbow Surg 18:897–902PubMedCrossRefGoogle Scholar
  25. 25.
    Coste JS, Reig S, Trojani C, Berg M, Walch G, Boileau P (2004) The management of infection in arthroplasty of the shoulder. J Bone Joint Surg Br 86:65–69PubMedGoogle Scholar
  26. 26.
    Dodson CC, Craig EV, Cordasco FA, Dines DM, Dines JS, Dicarlo E, Brause BD, Warren RF (2010) Propionibacterium acnes infection after shoulder arthroplasty: a diagnostic challenge. J Shoulder Elbow Surg 19:303–307PubMedCrossRefGoogle Scholar
  27. 27.
    Cuff DJ, Virani NA, Levy J, Frankle MA, Derasari A, Hines B, Pupello DR, Cancio M, Mighell M (2008) The treatment of deep shoulder infection and glenohumeral instability with debridement, reverse shoulder arthroplasty and postoperative antibiotics. J Bone Joint Surg Br 90:336–342PubMedCrossRefGoogle Scholar
  28. 28.
    Lutz MF, Berthelot P, Fresard A, Cazorla C, Carricajo A, Vautrin AC, Fessy MH, Lucht F (2005) Arthroplastic and osteosynthetic infections due to Propionibacterium acnes: a retrospective study of 52 cases, 1995–2002. Eur J Clin Microbiol Infect Dis 24:739–744PubMedCrossRefGoogle Scholar
  29. 29.
    Cui Q, Mihalko WM, Shields JS, Ries M, Saleh KJ (2007) Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty. J Bone Joint Surg Am 89:871–882PubMedCrossRefGoogle Scholar
  30. 30.
    Loebenberg MI, Zuckerman JD (2004) An articulating interval spacer in the treatment of an infected total shoulder arthroplasty. J Shoulder Elbow Surg 13:476–478PubMedCrossRefGoogle Scholar
  31. 31.
    Duncan CP, Beauchamp C (1993) A temporary antibiotic-loaded joint replacement system for management of complex infections involving the hip. Orthop Clin North Am 24:751–759PubMedGoogle Scholar
  32. 32.
    Haddad FS, Masri BA, Campbell D, McGraw RW, Beauchamp CP, Duncan CP (2000) The PROSTALAC functional spacer in two-stage revision for infected knee replacements. Prosthesis of antibiotic-loaded acrylic cement. J Bone Joint Surg Br 82:807–812PubMedCrossRefGoogle Scholar
  33. 33.
    Verhelst L, Stuyck J, Bellemans J, Debeer P (2011) Resection arthroplasty of the shoulder as a salvage procedure for deep shoulder infection: does the use of a cement spacer improve outcome? J Shoulder Elbow Surg 20:1224–1233PubMedCrossRefGoogle Scholar
  34. 34.
    Maynou C, Ménager S, Senneville E, Bocquet D, Mestdagh H (2006) Clinical results of resection arthroplasty for infected shoulder arthroplasty. Rev Chir Orthop Reparatrice Appar Mot 92:567–574PubMedCrossRefGoogle Scholar
  35. 35.
    Gallo RA, Gamradt SC, Mattern CJ, Cordasco FA, Craig EV, Dines DM, Warren RF (2011) Instability after reverse total shoulder replacement. J Shoulder Elbow Surg 20:584–590PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2013

Authors and Affiliations

  • Reinhold Ortmaier
    • 1
  • Herbert Resch
    • 1
  • Wolfgang Hitzl
    • 2
  • Michael Mayer
    • 3
  • Ottokar Stundner
    • 4
  • Mark Tauber
    • 5
  1. 1.Department of Traumatology and Sports InjuriesParacelsus Medical UniversitySalzburgAustria
  2. 2.Department of BiostatisticsParacelsus Medical UniversitySalzburgAustria
  3. 3.Department of Spine SurgeryWerner-Wicker-KlinikBad WildungenGermany
  4. 4.Department of AnesthesiologyParacelsus Medical UniversitySalzburgAustria
  5. 5.Shoulder and Elbow ServiceATOS Clinic MunichMunichGermany

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