Two-stage revision for periprosthetic shoulder infection yielded 18% reinfection rate
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Patients who underwent two-stage reverse shoulder arthroplasty for infection had a reinfection rate of 18% at midterm follow-up, according to results presented at the American Shoulder and Elbow Surgeons Annual Meeting.
Edward G. McFarland, MD, and colleagues analyzed 17 patients revised to a two-stage reverse shoulder arthroplasty for treatment of infection after TSA. The implant used during revision had a lateralized glenosphere, inlay humeral tray and a 135° neck shaft angle, according to McFarland.
“Failure was defined as revision of the prosthesis or a recurrent infection,” McFarland said in his presentation. “We also kept track of other complications, such as dislocations, fractures or notching.”
McFarland noted approximately three-fourths of patients had an elevated C-reactive protein level and patients also had an elevated erythrocyte sedimentation rate. Although 16 patients experienced successful aspiration, he added that only 31% of patients had positive aspiration fluid cultures. Among the patients who had aspiration, McFarland noted six patients had a white blood cell count greater than 3,000.
Humeral loosening occurred in 18% of patients, and 71% of patients had intraoperative organisms, of which 50% were Cutibacterium acnes, according to McFarland.
“In terms of histology, at the time of surgery, 100% of patients had greater than five white blood cells per high-power field,” he said. “When we applied [International Consensus Meeting] ICM criteria, basically for definite joint infection, 10 patients or 59% met criteria. Those criteria are presence of a sinus tract, gross intra-articular puss or two positive tissue cultures with the same virulent organism.”
According to McFarland, recurrent infection occurred in 18% of patients by 5-year follow-up. Periprosthetic fractures occurred in four shoulders, spacer fracture in one shoulder and one patient experienced dislocation, he noted.
“All patients had both statistical and clinically significant improvements in their patient- reported outcomes, including the VAS for pain, [American Shoulder and Elbow Surgeons] ASES, [simple shoulder test] SST and the [Western Ontario Osteoarthritis of the Shoulder Index] WOOS,” McFarland said. “Most patients had statistically significant improvement in elevation, but not so much in rotations.”
Perspective
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The authors of this article nicely describe their results on two-staged revisions for periprosthetic shoulder arthroplasty infections. Shoulder arthroplasty infections can be a devastating complication for patients and surgeons alike and this article shows that there can be promising results with a two-staged revision, even for this serious problem. While single-staged revision arthroplasty is a viable option for some patients with periprosthetic infections, two-staged revision remains the gold standard with promising results.
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Meshram P, et al. Midterm results of two-stage revision surgery for periprosthetic shoulder infection. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 2-3, 2020 (virtual meeting).
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