These authors reviewed 36 patients with a chronic periprosthetic shoulder infection after a reverse shoulder arthroplasty. Surgical treatment included débridement and implant retention (n=6); 1-stage revision (n=1); 2-stage revision (n=16); multiple stage revisions (> 2 stages) (n=7); definitive spacer (n=2) and resection arthroplasty (n=4). The most common causative pathogens were Staphylococcus epidermidis (n=11) and Cutibacterium acnes (n=9).
All four patients having a recurrent infection had been initially treated with débridement and implant retention.
As a result of their analysis of this small series, the authors suggest that patients with chronic periprosthetic infection of a reverse total shoulder should be treated with implant exchange.
This view is supported by the observation that chronic periprosthetic infections are associated with a biofilm on the implant (especially titanium alloy). In that antibiotics do not penetrate the biofilm easily, removal of the implant is needed to resolve the infection.