Short-term outcomes of two-stage reverse total shoulder arthroplasty with antibiotic-loaded cement spacer for shoulder infection

다국어 초록 (Multilingual Abstract)

Background: The purpose of our study was to investigate short-term outcomes of two-stage reverse total shoulder arthroplasty (RTSA) with an antibiotic-loaded cement spacer for shoulder infection. Methods: Eleven patients with shoulder infection were treated by two-stage RTSA following temporary antibiotic-loaded cement spacer. Of the 11 shoulders, nine had pyogenic arthritis combined with complex conditions such as recurrent infection, extensive osteomyelitis, osteoarthritis, or massive rotator cuff tear and two had periprosthetic joint infection (PJI). The mean follow-up period was 29.9 months (range, 12–48 months) after RTSA. Clinical and radiographic outcomes were evaluated using the visual analog scale (VAS) score for pain, American Shoulder and Elbow Surgeons (ASES) score, subjective shoulder value (SSV), and serial plain radiographs. Results: The mean time from antibiotic-loaded cement spacer to RTSA was 9.2 months (range, 1–35 months). All patients had no clinical and radiographic signs of recurrent infection at final follow-up. The mean final VAS score, ASES score, and SSV were significantly improved from 4.5, 38.6, and 29.1% before RTSA to 1.7, 75.1, and 75.9% at final follow-up, respectively. The mean forward flexion, abduction, external rotation, and internal rotation were improved from 50.0°, 50.9°, 17.7°, and sacrum level before RTSA to 127.3°, 110.0°, 51.8°, and L2 level at final follow-up, respectively. Conclusions: Two-stage RTSA with antibiotic-loaded cement spacer yields satisfactory short-term clinical and radiographic outcomes. In patients with pyogenic arthritis combined with complex conditions or PJI, two-stage RTSA with an antibiotic-loaded cement spacer would be a successful approach to eradicate infection and to improve function with pain relief.

참고문헌 (Reference)

1 Hattrup SJ, "Two-stage shoulder reconstruction for active glenohumeral sepsis" 33 : 20-, 2010

2 Buchalter DB, "Two-stage revision for infected shoulder arthroplasty" 26 : 939-947, 2017

3 Coffey MJ, "Treatment of glenohumeral sepsis with a commercially produced antibiotic-impregnated cement spacer" 19 : 868-873, 2010

4 CuffDJ, "The treatment of deep shoulder infection and glenohumeral instability with debridement, reverse shoulder arthroplasty and postoperative antibiotics" 90 : 336-342, 2008

5 Strickland JP, "The results of two-stage re-implantation for infected shoulder replacement" 90 : 460-465, 2008

6 Mirra JM, "The pathology of the joint tissues and its clinical relevance in prosthesis failure" (117) : 221-240, 1976

7 Coste JS, "The management of infection in arthroplasty of the shoulder" 86 : 65-69, 2004

8 Gilot G, "The incidence of radiographic aseptic loosening of the humeral component in reverse total shoulder arthroplasty" 24 : 1555-1559, 2015

9 Grubhofer F, "Staged revision with antibiotic spacers for shoulder prosthetic joint infections yields high infection control" 476 : 146-152, 2018

10 Leonard HA, "Single- or two-stage revision for infected total hip arthroplasty? A systematic review of the literature" 472 : 1036-1042, 2014

11 Kaveeshwar S, "Risk factors for increased shoulder Cutibacterium acnes burden" 4 : 464-469, 2020

12 Mileti J, "Reimplantation of a shoulder arthroplasty after a previous infected arthroplasty" 13 : 528-531, 2004

13 정석원, "Recent Updates Regarding Outcomes and Complications of Reverse Total Shoulder Arthroplasty" 대한견주관절학회 20 (20): 172-179, 2017

14 Bonnevialle N, "Periprosthetic shoulder infection : an overview" 2 : 104-109, 2017

15 Rispoli DM, "Pain relief and functional results after resection arthroplasty of the shoulder" 89 : 1184-1187, 2007

16 Beekman PD, "One-stage revision for patients with a chronically infected reverse total shoulder replacement" 92 : 817-822, 2010

17 Kennedy N, "Native joint septic arthritis: epidemiology, clinical features, and microbiological causes in a New Zealand population" 42 : 2392-2397, 2015

18 Zhang AL, "Management of deep postoperative shoulder infections : is there a role for open biopsy during staged treatment?" 24 : e15-20, 2015

19 Saper D, "Management of Propionibacterium acnes infection after shoulder surgery" 8 : 67-74, 2015

20 Sperling JW, "Infection after shoulder arthroplasty" (382) : 206-216, 2001

21 김수철 ; Il Su Kim ; Min Chang Jang ; Jae Chul Yoo, "Complications of reverse shoulder arthroplasty: a concise review" 대한견주관절학회 24 (24): 42-52, 2021

22 Memon M, "Arthroscopic management of septic arthritis of the native shoulder : a systematic review" 34 : 625-646, 2018

23 Goetti P, "Advanced septic arthritis of the shoulder treated by a two-stage arthroplasty" 10 : 356-363, 2019

24 Parvizi J, "AAOS Clinical practice guideline : diagnosis and treatment of periprosthetic joint infections of the hip and knee" 18 : 771-772, 2010