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Infection management in shoulder defined by timing, organism type
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CHICAGO — Management of infection in the shoulder is based on the timing of the infection, the host and organism type, according to research presented here.
In his presentation at the American Shoulder and Elbow Surgeons Open Symposium, John W. Sperling, MD, MBA, noted that at the Mayo Clinic, infection is classified as positive culture at revision surgery (type 1), acute infection within 30 days of surgery (type 2), acute hematogenous infection (type 3) or chronic infection (type 4). For treatment, debridement should be considered in an early postoperative infection or acute infection with a well-functioning prosthesis, he noted. However, a type 4 infection would be treated with either a one- or two-stage procedure.
“It really does depend on the organism, as well as surgeon preference,” Sperling said.
According to Sperling, a two-stage implantation is the most accepted approach to treat a type 4 infection, with previously published studies showing positive results. Templating the spacer ahead of time can help make a two-stage procedure more efficient, he added, and it allows surgeons to customize the spacer by including antifungal agents if necessary. – by Casey Tingle
Reference:
Sperling JW. Infection: Retain or remove implant? — When do we have a choice and when not. Presented at: American Shoulder and Elbow Surgeons Open Symposium; Oct. 11, 2018; Chicago.
Disclosure: Sperling reports he received royalties from Biomet.