Advanced septic arthritis of the shoulder treated by a two-stage arthroplasty.

Details

Serval ID
serval:BIB_08844320433C
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Advanced septic arthritis of the shoulder treated by a two-stage arthroplasty.
Journal
World journal of orthopedics
Author(s)
Goetti P., Gallusser N., Antoniadis A., Wernly D., Vauclair F., Borens O.
ISSN
2218-5836 (Print)
ISSN-L
2218-5836
Publication state
Published
Issued date
18/10/2019
Peer-reviewed
Oui
Volume
10
Number
10
Pages
356-363
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
The usual treatment of septic shoulder arthritis consists of arthroscopic or open lavage and debridement. However, in patients with advanced osteoarthritic changes and/or massive rotator cuff tendon tears, infection eradication can be challenging to achieve and the functional outcome is often not satisfying even after successful infection eradication. In such cases a two-stage approach with initial resection of the native infected articular surfaces, implantation of a cement spacer before final treatment with a total shoulder arthroplasty in a second stage is gaining popularity in recent years with the data in literature however being still limited.
To evaluate the results of a short interval two-stage arthroplasty approach for septic arthritis with concomitant advanced degenerative changes of the shoulder joint.
We retrospectively included five consecutive patients over a five-year period and evaluated the therapeutic management and the clinical outcome assessed by disability of the arm, shoulder and hand (DASH) score and subjective shoulder value (SSV). All procedures were performed through a deltopectoral approach and consisted in a debridement and synovectomy, articular surface resection and insertion of a custom made antibiotic enriched cement spacer. Shoulder arthroplasty was performed in a second stage.
Mean age was 61 years (range, 47-70 years). Four patients had previous surgeries ahead of the septic arthritis. All patients had a surgical debridement ahead of the index procedure. Mean follow-up was 13 mo (range, 6-24 mo). Persistent microbiological infection was confirmed in all five cases at the time of the first stage of the procedure. The shoulder arthroplasties were performed 6 to 12 wk after insertion of the antibiotic-loaded spacer. There were two hemi and three reverse shoulder arthroplasties. Infection was successfully eradicated in all patients. The clinical outcome was satisfactory with a mean DASH score and SSV of 18.4 points and 70% respectively.
Short interval two-stage approach for septic shoulder arthritis is an effective treatment option. It should nonetheless be reserved for selected patients with advanced disease in which lavage and debridement have failed.
Keywords
Antibiotic, Arthroplasty, Enriched, Infection, Native joint, Septic arthritis, Shoulder, Spacer
Pubmed
Web of science
Open Access
Yes
Create date
02/12/2019 13:58
Last modification date
17/12/2019 7:23
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