Monday, October 9, 2017

Two stage revision shoulder arthroplasty – how often do we get to stage 2?

A paper entitled "STAGE 1 SHOULDER ARTHROPLASTY: RISK FACTORS FOR REPEAT STAGE 1, SPACER RETENTION AND MORTALITY" was presented at the 2017 open meeting of the American Shoulder and Elbow Surgeons (see this link).

These authors sought to provide the perspective from a national Medicare database on the the outcomes at one year following stage 1 shoulder arthroplasty revision for patients who underwent removal of an infected shoulder prosthesis and placement of an antibiotic spacer.

975 patients who underwent shoulder arthroplasty prosthesis removal and cement spacer placement for infection met all inclusion and exclusion criteria. Within 1 year postoperatively, 21 patients died (2.2%), 70 patients had a repeat stage I procedure (7.2%), 55 patients had a girdlestone-type procedure (5.6%), 349 patients retained their spacers (35.8%) and the remaining 480 patients had a shoulder arthroplasty re-implanted (49.2%)

Independent risk factors for death within 1 year following stage 1 revision included older age, alcohol use, coronary artery disease (CAD) and hemodialysis

Independent risk factors for repeat Stage 1 revision include younger age, morbid obesity, diabetes mellitus and coronary artery disease. 

Independent risk factors for no re-implantation within one year include female gender, older age, tobacco use, alcohol use and inflammatory arthritis.

Only half of patients underwent re-implantation. 

One third of patients retained their spacer and just less than 10% repeated a stage 1 procedure.

Comment: We surely look forward to the publication of the full paper that would include the details of the type of infection and the condition of the shoulder. However, this abstract does indicate that a two stage revision is not always completed, leaving the patient with either a spacer or a resection arthroplasty.


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