Wednesday, October 28, 2015

Reverse total shoulder - infection

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

These authors reviewed 32 patients (71 (55-83) years) who were reoperated on for infection after reversed shoulder arthroplasty between 1996 and 2011. A total of 38 procedures were performed: d├ębridement (13), 1-stage (5) or 2-stage revision (14), or implant removal (6). Six of these patients needed 2 successive procedures.  The complication rate was 26%.

Infections were largely caused by coagulase-negative staphylococci (56%) and Propionibacterium acnes (59%).

At last follow-up, 26 patients appeared to be free of infection (81%).

Comment: With coagulase-negative staphylococci and Propionibacterium it is difficult to know whether a shoulder is free of infection. These infections may smolder only to reappear months or years after a surgical revision. These bacteria are known to form biofilms so that resolution of an infection usually requires implant exchange and removal of any cement used for component fixation. This implant exchange is made much more complex with bone ingrowth or 'platform' prostheses or when the humeral component is cemented as shown below


For that reason, whenever possible we fix the humeral component with impaction grafting as described here.

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