Introduction: Management of periprosthetic joint infection (PJI) in shoulder arthroplasty remains a challenge, with no established gold-standard treatment. This study presents the unique experience of a high volume, single institution-surgeon approach on staged revision reverse total shoulder arthroplasty (RTSA) for infection. The authors theorize staged revision RTSA is an effective treatment for PJI. Materials & methods: Between 2013 to 2018, 38 patients underwent a staged RTSA for treatment of PJI. Patient histories were collected and classified using Cierny-Mader classification. Infection workup for all patients included x-rays, laboratory indices, and computed tomographic aspiration arthrogram (CTAA). PJI was identified based on high clinical and radiographic suspicion, elevated serologic markers, and/or aspirate culture results per 2018 International Consensus Meeting Shoulder guidelines on Orthopedic Infections. All patients underwent first stage with implant removal, irrigation and débridement, and antibiotic spacer placement. Next, intravenous antibiotics were administered by infectious disease consultants for minimum of 6 weeks. Infection workup was then repeated and, if normalized, final stage revision commenced with antibiotic spacer removal and revision to RTSA. If indices were persistently abnormal, an additional stage of débridement and spacer placement procedure was performed. Treatment failure was defined as recurrent periprosthetic infection after final prosthesis implantation or persistently elevated indices despite adequate débridement and spacer placement. Results: Mean age of the cohort was 68 ±8.9 years (SD) and mean follow-up was 33 ±14 months (SD) with 34 Cierny-Mader C hosts and 4 B hosts. Patients underwent mean of 2 ±1.1 previous surgeries (SD). The staged revision protocol was successful in 34 (89.5%) patients for management of PJI. Four patients (10.5%) were considered failures with recurrent infections at mean of 13 months (range 2-26 months) after the final RTSA implantation and underwent repeat staged revisions. Of the 34 patients who had successful infection eradication, 31 had 2-stage treatment and 3 had to undergo 3-stages. There were no treatment-associated mortalities and 10 major complications (26%), including permanent neuropathy, instability, and periprosthetic fractures. Most common cultured microorganism was Cutibacterium acnes (18%), with no polymicrobial infections detected. Discussion: While there are multiple treatment options for PJI management, staged revision remains an effective means of treatment. Although there were several patients who required an additional stage of treatment, and a significant complication rate, staged revision RTSA proved successful in the ultimate eradication of the PJI. Keywords: Cierny-Mader classification; Periprosthetic joint infection; antibiotic spacer; reverse total shoulder arthroplasty; stage revision.
Success of Staged Revision Reverse Total Shoulder Arthroplasty in Eradication of Periprosthetic Joint Infection
Garofalo R;
2022-01-01
Abstract
Introduction: Management of periprosthetic joint infection (PJI) in shoulder arthroplasty remains a challenge, with no established gold-standard treatment. This study presents the unique experience of a high volume, single institution-surgeon approach on staged revision reverse total shoulder arthroplasty (RTSA) for infection. The authors theorize staged revision RTSA is an effective treatment for PJI. Materials & methods: Between 2013 to 2018, 38 patients underwent a staged RTSA for treatment of PJI. Patient histories were collected and classified using Cierny-Mader classification. Infection workup for all patients included x-rays, laboratory indices, and computed tomographic aspiration arthrogram (CTAA). PJI was identified based on high clinical and radiographic suspicion, elevated serologic markers, and/or aspirate culture results per 2018 International Consensus Meeting Shoulder guidelines on Orthopedic Infections. All patients underwent first stage with implant removal, irrigation and débridement, and antibiotic spacer placement. Next, intravenous antibiotics were administered by infectious disease consultants for minimum of 6 weeks. Infection workup was then repeated and, if normalized, final stage revision commenced with antibiotic spacer removal and revision to RTSA. If indices were persistently abnormal, an additional stage of débridement and spacer placement procedure was performed. Treatment failure was defined as recurrent periprosthetic infection after final prosthesis implantation or persistently elevated indices despite adequate débridement and spacer placement. Results: Mean age of the cohort was 68 ±8.9 years (SD) and mean follow-up was 33 ±14 months (SD) with 34 Cierny-Mader C hosts and 4 B hosts. Patients underwent mean of 2 ±1.1 previous surgeries (SD). The staged revision protocol was successful in 34 (89.5%) patients for management of PJI. Four patients (10.5%) were considered failures with recurrent infections at mean of 13 months (range 2-26 months) after the final RTSA implantation and underwent repeat staged revisions. Of the 34 patients who had successful infection eradication, 31 had 2-stage treatment and 3 had to undergo 3-stages. There were no treatment-associated mortalities and 10 major complications (26%), including permanent neuropathy, instability, and periprosthetic fractures. Most common cultured microorganism was Cutibacterium acnes (18%), with no polymicrobial infections detected. Discussion: While there are multiple treatment options for PJI management, staged revision remains an effective means of treatment. Although there were several patients who required an additional stage of treatment, and a significant complication rate, staged revision RTSA proved successful in the ultimate eradication of the PJI. Keywords: Cierny-Mader classification; Periprosthetic joint infection; antibiotic spacer; reverse total shoulder arthroplasty; stage revision.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
