Saturday, June 20, 2015

Reverse total shoulder arthroplasty - the problem of infection

Surgical management of the infected reversed shoulder arthroplasty: a French multicenter study of reoperation in 32 patients.

These authors reviewed patients who were reoperated on for infection after reversed shoulder arthroplasty between 1996 and 2011. The mean age was 71 (55-83) years. The involved implants were primary prostheses in 23 cases and revision prostheses in 9 cases. The average delay between the prosthesis implantation and the diagnosis of infection was 21 months (1-116).

Infections were largely caused by coagulase-negative staphylococci (56%) and Propionibacterium acnes (59%). The complication rate was 26%. At last follow-up, 26 patients appeared to be free of infection. After d├ębridement with implant retention, the healing rate was only 54%. Single or two stage implant revision led to better functional results than implant removal, with superior healing rates (73% and 67%, respectively). Patients with low initial impairment (Constant score > 30) were not significantly improved by surgical treatment.

Comment: This paper does not clarify the optimal methods for diagnosing or treating infections - there was great variability in the approach in these cases. What we can take away is that (1) the presentation of infection can be long - 10 years - after the index procedure, (2) as is the case for anatomic shoulder arthroplasty infections, Propionibacterium is the most common bacterium isolated from these cases, (3) the rate of infection after reverse total shoulders is not determined, and (4) the minimum one year followup in this series is insufficient to judge whether or not the infection was eradicated.

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