Abstract
BackgroundThe objective of this study is to present the results of cement spacer sonication in the second stage of two-stage treatment of shoulder arthroplasty infection and to determine the rate of positive cultures in the second-stage surgery in shoulder arthroplasty and its meaning.MethodsTwenty-one patients (22 cement spacers) treated with two-stage surgery because of a shoulder arthroplasty infection were included. In the second stage, the cement spacer was sent for sonication and at least four tissue cultures were obtained. Epidemiological data, comorbidities, sensitivity of the microorganisms to the antibiotic loaded in the cement spacer in the first revision surgery, time elapsed since an antibiotic was last administered until second revision procedure, functional shoulder status at last follow-up, and any complication were recorded.ResultsThree out of the 22 cases (13.6%) presented positive cultures at the second-stage surgery. Periprosthetic tissue culturing detected the three positive culture cases in the second stage while the cement spacer sonication detected two and missed one. Considering periprosthetic tissue culturing as the standard procedure, the cement spacer sonication showed sensitivity at 66.6%. Recurrent infection over time was considered present in 3 patients; two of them had been previously diagnosed with a positive culture at the second stage (66.6%).ConclusionsA good number of patients (13.6%) present a positive culture at the second stage of the two-stage surgical procedure for infected shoulder arthroplasty, and those patients seem to be at high risk for recurrent infection. Periprosthetic tissue cultures have a higher sensitivity to detecting a positive culture at the second stage than cement spacer sonication.
Highlights
The objective of this study is to present the results of cement spacer sonication in the second stage of two-stage treatment of shoulder arthroplasty infection and to determine the rate of positive cultures in the second-stage surgery in shoulder arthroplasty and its meaning
Despite reasonable good results having been reported with the one-stage treatment of deep infections in shoulder arthroplasty, the gold standard treatment for chronic Periprosthetic joint infection (PJI) in shoulder remains the two-stage exchange using an antibiotic-loaded cement spacer between surgeries to maintain the tension of the soft tissue as well as to deliver the antibiotic [1,2,3,4,5,6,7,8,9]
As defined by Zimmerli et al, infection was diagnosed if at least one of the following criteria was present: growth of the same microorganism in two or more cultures of synovial fluid or periprosthetic tissue, purulence of synovial fluid or at the implant site, acute inflammation on histopathological examination of periprosthetic tissue, or presence of a sinus tract communicating with the prosthesis [24]
Summary
The objective of this study is to present the results of cement spacer sonication in the second stage of two-stage treatment of shoulder arthroplasty infection and to determine the rate of positive cultures in the second-stage surgery in shoulder arthroplasty and its meaning. Two-stage arthroplasty exchange still represents the standard way to manage PJI in hips and knees, but it has been reported that it may be successful in only 73% of the cases in knee arthroplasty and has a re-infection rate of 27% during follow-up [12]. It has been documented, in hip and knee arthroplasty, that positive cultures may be still present in up to 20% of the Torrens et al Journal of Orthopaedic Surgery and Research (2018) 13:58 cases undergoing two-stage procedure in the second stage. Little information is available relative to the rate of positive cultures in the second-stage surgery in shoulder arthroplasty and its meaning [14, 15]
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