Periprosthetic Infections of the Shoulder Joint: Characteristics and 5-Year Outcome of a Single-Center Series of 19 Cases.

Mohamad Bdeir,Elio Assaf,Svetlana Hetjens,Ali Darwich,Franz-Joseph Dally,Sascha Gravius,Elisabeth Mohs

doi:10.3390/antibiotics10091125

Abstract

Periprosthetic shoulder infection (PSI) remains a devastating complication after total shoulder arthroplasty (TSA). Furthermore, there is a paucity in the literature regarding its diagnostic and therapeutic management, especially the absence of therapy concepts devised exclusively for PSI. The aim of the presenting study is to examine the characteristics and outcome of patients with PSI who were treated according to well-established algorithms developed originally for periprosthetic joint infection (PJI) of the hip and knee and determine if these algorithms can be applied to PSI. This single-center case series included all patients with a PSI presenting between 2010 and 2020. Recorded parameters included age, sex, affected side, BMI, ASA score, Charlson comorbidity index, preoperative anticoagulation, indication for TSA (fracture, osteoarthritis or cuff-arthropathy), and type of infection (acute or chronic PSI). The outcome was divided into treatment failure or infect resolution. Staphylococcus epidermidis and aureus were the commonest infecting pathogens. Acute PSI was mainly treated with debridement, irrigation, and retention of the prosthesis (DAIR) and chronic cases with two/multiple-stage exchange. The treatment failure rate was 10.5%. C-reactive protein was preoperatively elevated in 68.4% of cases. The mean number of operative revisions was 3.6 ± 2.6, and the mean total duration of antibiotic treatment was 72.4 ± 41.4 days. The most administered antibiotic was a combination of clindamycin and fluoroquinolone. In summary, the data of the current study suggest that therapeutical algorithms and recommendations developed for the treatment of PJI of the hip and knee are also applicable to PSI.

Highlights

Total shoulder joint arthroplasty (TSA) experienced in the last years’ considerable advancements and is nowadays a well-established treatment option for various diagnoses such as proximal humerus fracture, osteoarthritis, and cuff tear arthropathy in the elderly [1,2,3]
On the one hand, the spectrum of infecting microorganisms in periprosthetic joint infection (PJI) vary between the shoulder and the hip/knee and on the other hand, significant anatomical and biomechanical differences are present, management of periprosthetic shoulder infection (PSI) and the different modalities of surgical therapy are often based on guidelines for PJI of the hip or knee
Between 2010 and 2020, a total of 19 patients presented with a PSI were included in this retrospective single-center case series

Summary

Introduction

Total shoulder joint arthroplasty (TSA) experienced in the last years’ considerable advancements and is nowadays a well-established treatment option for various diagnoses such as proximal humerus fracture, osteoarthritis, and cuff tear arthropathy in the elderly [1,2,3]. On the one hand, the spectrum of infecting microorganisms in periprosthetic joint infection (PJI) vary between the shoulder and the hip/knee and on the other hand, significant anatomical and biomechanical differences are present, management of PSI and the different modalities of surgical therapy are often based on guidelines for PJI of the hip or knee. These include debridement, irrigation, and retention of the prosthesis (DAIR), one-, two- or multiple-stage exchange and resection arthroplasty [14,15,16,17,18]

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Results

Discussion

Conclusion