Abstract
Periprosthetic joint infection (PJI) is a catastrophic complication of shoulder arthroplasty. Commonly used surgical treatments include one- or two-stage revision, but their effectiveness in controlling infection is uncertain. We aimed to compare re-infection (recurrent and new infections) rates; clinical measures of function and pain; and noninfection complication rates of one- and two-stage revision surgery for shoulder PJI using a systematic review and meta-analysis. We searched MEDLINE, Embase, Web of Science, and The Cochrane Library to February 2018. Longitudinal studies conducted in patients with shoulder PJI treated exclusively by one- or two-stage revision were eligible. No clinical trials were identified. Re-infection rates were meta-analysed using random-effect models after arcsine transformation. The re-infection rate (95% CI) in pooled analysis of eight one-stage studies (147 participants) was 5.3% (1.4–10.6). The corresponding rate for 27 two-stage studies (351 participants) was 11.5% (6.0–18.1). Postoperative clinical measures of function and pain were not significantly different between the two revision strategies. The pooled noninfection complication rate (95% CI) for one-stage and two-stage revision was 12.1% (6.1–19.5) and 18.9% (8.4–31.9) respectively. New evidence suggests one-stage revision is at least equally as effective as the two-stage in controlling infection, maintaining joint function, and improving complications in shoulder PJI.
Highlights
For many people with severe gleno-humeral disease, fracture, avascular necrosis or rotator cuff wear, shoulder arthroplasty is considered the most effective surgical intervention for alleviating pain and disability
As with Periprosthetic joint infection (PJI) after hip and knee arthroplasty, the two-stage revision strategy is regarded as the standard treatment option for shoulder PJI because it is generally consistently associated with good rates of infection control[10,11,12]
After exclusions based on titles and abstracts, 55 articles remained for detailed evaluation
Summary
For many people with severe gleno-humeral disease, fracture, avascular necrosis or rotator cuff wear, shoulder arthroplasty is considered the most effective surgical intervention for alleviating pain and disability. As with PJIs after hip and knee arthroplasty, the two-stage revision strategy is regarded as the standard treatment option for shoulder PJI because it is generally consistently associated with good rates of infection control[10,11,12]. Several new individual studies have been published recently In this context, using a systematic review and meta-analysis, we aimed to conduct a detailed and robust comparison of the effectiveness of the one- and two-stages revision strategies for shoulder PJI using re-infection as a primary outcome and under a range of study-level clinical characteristics. Secondary objectives included (i) comparing the effectiveness of the one- and two-stage revision strategies using other clinical outcomes such as measures of function, pain, and satisfaction as well as noninfection-related complication rates and (ii) to explore for potential sources of heterogeneity between studies and assess publication bias
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