Tailored modular spacers and handmade spacers in periprosthetic shoulder infection: clinical and functional results after 2-year follow-up

Abstract

BackgroundThe diagnosis and treatment of periprosthetic shoulder infections are challenging; two-stage procedure using antibiotic-loaded spacers offers appropriate infection resolution and satisfactory clinical results. The main purpose of this study was to compare functional results in patients who keep different type of spacers as definitive treatment after first-stage procedure for periprosthetic shoulder infections. Secondary aim was to evaluate clinical and functional scores comparing patients who still hold the spacers with patients who already underwent prosthesis reimplantation. Materials and MethodsForty eight patients treated with tailored modular (TM) or handmade (HM) spacer for shoulder chronic infection were enrolled. Twenty five patients (52.1%) underwent reverse shoulder arthroplasty implantation; 23 patients (47.9%) decided to hold the spacer and to continue to use it as a functional prosthesis (17 TM spacers, 6 HM spacers). Clinical data were recorded and functional scores were calculated at 35.2-month follow-up after last shoulder surgical procedure. Visual analog pain scale was used to measure pain; Constant Score, Simple Shoulder Test, Disabilities of the Arm, Shoulder and Hand Score, and American Shoulder and Elbow Surgeons score were calculated to assess shoulder function. ResultsWe found no significant score differences in patients treated with different kind of antibiotic spacers after first-stage and second-stage procedure. Prosthesis reimplantation seems to be the best option for patients who are motivated, active, and medically stable, achieving better functional results compared to spacer retention, although we found no statistically significant improvement in pain reduction before and after prosthesis reimplantation. ConclusionsTwo-stage exchange procedures with antibiotic spacer are highly effective in infections eradication. No superiority was found in TM spacers over HM ones when the spacer was retained and when the second-stage procedure took place. Second-stage procedure appears to be effective only in improving shoulder function and not in reducing pain regardless of the kind of antibiotic-loaded spacer used. We suggest to avoid second-stage procedure in low-demanding patients with reasonable shoulder function and acceptable pain control (visual analog scale <3).