Abstract
Background
If osteomyelitis is confined to the proximal humerus, arthroscopic debridement with multiple punctures at the infected bone might be sufficient to eradicate the septic shoulder with bone involvement.
Materials and Methods
From 2005 to 2017, 15 patients received arthroscopic debridement with multiple punctures. We included patients with septic shoulder arthritis with proximal bone involvement and excluded patients with glenohumeral joint destruction or extension of bone involvement to the diaphysis of the humerus. We performed multiple punctures for drainage of proximal humerus after complete arthroscopic debridement of septic soft tissue. Infection laboratory studies and postoperative magnetic resonance image were evaluated. For clinical outcome measurements, range of motion, pain visual analog scale, functional visual analog scale, American shoulder elbow surgeon scores, constant scores, and simple shoulder test were evaluated.
Results
There were 11 males and 4 females with a mean age of 53 years (range 28–73 years). Mean follow-up was 32 months (range 12–115 months). There was no reinfection case. The postoperative C-reactive protein levels were normalized in all. The postoperative magnetic resonance image showed no bony involvement of the proximal humerus in all patients except one patient. The clinical scores and range of motion were significantly improved postoperatively. Six patients underwent secondary surgery for rotator cuff tear at a mean time period of 25 months (range 4–104 months) from the index period.
Conclusion
Septic shoulder with proximal bone involvement can be successfully treated with arthroscopic debridement with multiple punctures.
Level of Evidence
Level IV, treatment study
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References
Jiang, J. J., Piponov, H. I., Mass, D. P., Angeles, J. G., & Shi, L. L. (2017). Septic Arthritis of the shoulder: a comparison of treatment methods. Journal of American Academy of Orthopaedic Surgeons, 25, e175–e184.
Geirsson, A. J., Statkevicius, S., & Vikingsson, A. (2008). Septic arthritis in Iceland 1990–2002: Increasing incidence due to iatrogenic infections. Annals of the Rheumatic Diseases, 67, 638–643.
Kennedy, N., Chambers, S. T., Nolan, I., Gallagher, K., Werno, A., Browne, M., et al. (2015). Native joint septic arthritis: Epidemiology, clinical features, and microbiological causes in a New Zealand population. Journal of Rheumatology, 42, 2392–2397.
Tahami, S. M., Aminian, A., & Azarpira, N. (2020). Experimental study on protective role of NSAID on articular cartilage destruction in septic arthritis. The Archives of Bone and Joint Surgery, 8, 89–93.
Wada, A., Fujii, T., Takamura, K., Yanagida, H., Urano, N., & Surijamorn, P. (2007). Operative reconstruction of the severe sequelae of infantile septic arthritis of the hip. Journal of Pediatric Orthopedics, 27, 910–914.
Sahu, K. K., Tsitsilianos, N., Moselle, L., & Mishra, A. K. (2020). Septic arthritis of hip joint and its devastating complications. BMJ Case Reports, 13, e233909.
Duncan, S. F., & Sperling, J. W. (2008). Treatment of primary isolated shoulder sepsis in the adult patient. Clinical Orthopaedics and Related Research, 466, 1392–1396.
Kirchhoff, C., Braunstein, V., Buhmann Kirchhoff, S., Oedekoven, T., Mutschler, W., & Biberthaler, P. (2009). Stage-dependant management of septic arthritis of the shoulder in adults. International Orthopaedics, 33, 1015–1024.
Abdel, M. P., Perry, K. I., Morrey, M. E., Steinmann, S. P., Sperling, J. W., & Cass, J. R. (2013). Arthroscopic management of native shoulder septic arthritis. Journal of Shoulder and Elbow Surgery, 22, 418–421.
Bohler, C., Pock, A., Waldstein, W., Staats, K., Puchner, S. E., Holinka, J., et al. (2017). Surgical treatment of shoulder infections: A comparison between arthroscopy and arthrotomy. Journal of Shoulder and Elbow Surgery, 26, 1915–1921.
Stutz, G., Kuster, M. S., Kleinstuck, F., & Gachter, A. (2000). Arthroscopic management of septic arthritis: stages of infection and results. Knee Surgery, Sports Traumatology, Arthroscopy, 8, 270–274.
Garofalo, R., Flanagin, B., Cesari, E., Vinci, E., Conti, M., & Castagna, A. (2014). Destructive septic arthritis of shoulder in adults. Musculoskeletal Surgery, 98(Suppl 1), 35–39.
Richards, R. R., An, K. N., Bigliani, L. U., Friedman, R. J., Gartsman, G. M., Gristina, A. G., et al. (1994). A standardized method for the assessment of shoulder function. Journal of Shoulder and Elbow Surgery, 3, 347–352.
L'Insalata, J. C., Warren, R. F., Cohen, S. B., Altchek, D. W., & Peterson, M. G. (1997). A self-administered questionnaire for assessment of symptoms and function of the shoulder. Journal of Bone and Joint Surgery. American Volume, 79, 738–748.
Hsu, J. E., Russ, S. M., Somerson, J. S., Tang, A., Warme, W. J., & Matsen, F. A., 3rd. (2017). Is the simple shoulder test a valid outcome instrument for shoulder arthroplasty? Journal of Shoulder and Elbow Surgery, 26, 1693–1700.
Aim, F., Delambre, J., Bauer, T., & Hardy, P. (2015). Efficacy of arthroscopic treatment for resolving infection in septic arthritis of native joints. Orthopaedics and Traumatology: Surgery and Research, 101, 61–64.
Jeon, I. H., Choi, C. H., Seo, J. S., Seo, K. J., Ko, S. H., & Park, J. Y. (2006). Arthroscopic management of septic arthritis of the shoulder joint. Journal of Bone and Joint Surgery. American Volume, 88, 1802–1806.
Atesok, K., MacDonald, P., Leiter, J., McRae, S., Stranges, G., & Old, J. (2017). Postoperative deep shoulder infections following rotator cuff repair. World Journal of Orthopedics, 8, 612–618.
Coffey, M. J., Ely, E. E., & Crosby, L. A. (2010). Treatment of glenohumeral sepsis with a commercially produced antibiotic-impregnated cement spacer. Journal of Shoulder and Elbow Surgery, 19, 868–873.
Assenmacher, A. T., Alentorn-Geli, E., Dennison, T., Baghdadi, Y. M. K., Cofield, R. H., Sanchez-Sotelo, J., et al. (2017). Two-stage reimplantation for the treatment of deep infection after shoulder arthroplasty. Journal of Shoulder and Elbow Surgery, 26, 1978–1983.
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Shim, J.W., Hong, S.W., Jeong, J.Y. et al. Clinical Results after Arthroscopic Treatment of Septic Shoulder with Proximal Bone Involvement. JOIO 55 (Suppl 1), 167–175 (2021). https://doi.org/10.1007/s43465-020-00095-6
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DOI: https://doi.org/10.1007/s43465-020-00095-6