Revision hip arthroplasty and infection in shoulder arthroplasty: What do the experts know?

Issue: March 2017

With the global increase in the need for arthroplasty, hip surgeons will need to perform more revision surgeries. Are you one of them? Do you wish to evaluate in depth which options you have to strengthen your hip revision practice?

Although uncommon, infection after shoulder arthroplasty can be a devastating complication that can occur years after the surgery. As experience is limited, would you be interested in acquiring more extensive knowledge of such conditions?

Two Interactive Expert Exchange (IEE) sessions at our upcoming EFORT Congress in Vienna can bring you insights into these topics.

Hip surgeons confront great challenges to fulfill the expectations around revision, both because of the disability patients can sustain, but also in terms of the technical skills required to deal with postoperative problems. The complexity of the revision procedure will depend on the medical history of the patient and on the pathology causing the revision. Difficulties like infection, an adverse response to metal-on-metal, corrosion-related diseases, bone stock deficiencies, periprosthetic fractures or soft-tissue complications remain huge problems to solve, whereas disruption of the hip musculature or nerve damage are almost irrevocable situations. Indeed, revision surgery has complications in terms of wound and muscle healing but also in terms of implant-to-bone healing and the fact that stability is not always immediate. The principles of revision surgery should be doing the right thing at the right time for each patient to avoid further surgery.

On the other hand, as the implants in revision hip surgery have evolved dramatically during the past 2 decades and now provide solutions for patients who are otherwise extremely disabled, implant use will undoubtedly increase in specialist centers even though some of these devices are expensive, particularly porous metal solutions, complex stems and bespoke sockets.

Revision Hip Arthroplasty | Friday 2 June 2017 | 10:15 to 12:30

Introduction & Moderation: George Macheras (Greece)

Questions and Presentations

Dealing with Bone Loss on the Acetabular Side – Prof. Jean-Noël Argenson (France)

Dealing with Bone Loss on the Femoral Side – Prof. Willem Schreurs (The Netherlands)

Periprosthetic Fractures: The Place for Osteosynthesis – Prof. Carsten Perka (Germany)

Periprosthetic Fractures: The Place for Revision – Prof. Fares Haddad (United Kingdom)

Discussion on Clinical Cases

Provocateurs: Theofilos Karachalios (Greece), Mazhar Tokgozoglu (Turkey)

During this session, important requirements like the type of imaging, surgical planning strategies and methods of treatment, as well as crucial factors for decision-making will be discussed. During revision, hip surgeons should can change the procedure intraoperatively if there are unexpected findings or complications, as the first attempt to reconstruct is always the best chance to restore patients function. Many techniques and technologies available to any hip revision surgical team will be analysed to define critical parameters to consider for avoiding any additional surgery.

The Infected Shoulder Arthroplasty | Thursday 1 June 2017 | 10:15 to 12:30

As the incidence of infection following shoulder arthroplasty is low, many questions remain. What are some clinical parameters that raise the suspicion of shoulder arthroplasty infection? What radiological signs are essential to analyze when a shoulder infection is suspected? How do blood tests correlate with positive cultures and which additional tests should be used?

Indeed, diagnosis is not effortless and mainly relies on concomitant analysis of several clinical symptoms, laboratory measurements and radiological observations that separately cannot be directly linked to this specific condition. Moreover, in regard to patient functionality, postoperative management of infected implants is often unsatisfactory and does not guarantee that the risk of a persisting infection will be eliminated. Two-stage exchange procedures, revision arthroplasty and debridement are options to consider, but are not always suitable for each case. The choice of the treatment depends also on the final outcome expected, but more questions arise such as: What parameters are predictive of the outcome? What exactly are the possible outcomes?

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Introduction and Moderation: Nicolas Holzer (Switzerland)

Questions and Presentations

Suspicion of infection in shoulder arthroplasty - Mr. Tobias Baring (United Kingdom)

P. Acnes and orthopaedic surgery - Dr. Elia Coppens (Switzerland)

Strategies for management of infected shoulder arthroplasty - Prof. Fançois Sirveau (France) - TBC

Functional outcomes after revision surgery for infection in shoulder arthroplasty - Dr. Hampus Mörner (Sweden) - TBC

Multiple revision of shoulder arthroplasty – Dr. Nicolas Holzer (Switzerland)

Discussion on Clinical Cases

This IEE will allow participants to consider infection after shoulder arthroplasty from diagnosis to multiple revision and highlight different approaches for treatment and potential outcomes. The sharing experience carried on during the session will set an ensemble of medical solutions to help shoulder surgeons face this type of complication.

The IEEs are paid sessions and preregistration is mandatory up to a maximum of 80 participants on a first-come, first-serve basis. IEE sessions may be attended only if the participant is already registered for the EFORT Congress. All details to sign-up for any of these sessions are available on our registration platform.