Abstract
Background: Patients with a periprosthetic joint infection (PJI) of the shoulder, who fail to undergo reimplantation in an attempted two-stage exchange seem to be neglected in the current literature. The aim of this study was to assess the clinical course of patients after the first stage in the process of an attempted two-stage exchange for shoulder PJI. Methods: After a retrospective review of our institutional database between 2008 and 2018, 49 patients, who were treated with an intended two-stage exchange for shoulder PJI, were identified. Patients’ demographics, laboratory and health status parameters, along with records of clinical outcome were collected. The primary outcome measurements analyzed were infection eradication, successful reimplantation, and patient survival. Results: Reimplantation was completed in only 35 (71%) of 49 cases and eradication of infection was achieved in 85.7% of patients with successful reimplantation after a mean follow-up duration of 5.1 years (1.1 to 10.2 years). Reasons for failure to reimplant were premature death in 36%, high general morbidity in 29%, satisfaction with the current status in 21%, or severe infection with poor bone and soft tissues in 14% of the patients. Of the 14 cases without reimplantation, eradication rate of infection was 57% after a mean follow-up of 5 years (2.6 to 11 years). The overall mortality rate of the entire cohort was 25% at the latest follow-up and 10% within ninety days after implant removal. Patients who deceased or did not undergo reimplantation during the follow-up were significantly older and had a significantly higher Charlson comorbidity index (CCI). Conclusions: While the two-stage exchange arthroplasty can lead to high rates of infection eradication, a considerable subset of patients never undergoes the second stage for a variety of reasons. Shoulder PJI and its treatment are associated with a high risk of mortality, especially in patients with older age and higher CCI.
Highlights
The current study aimed at evaluating all patients who underwent an attempted two-stage exchange arthroplasty for shoulder periprosthetic joint infection (PJI), irrespective of the subsequent clinical course, and demonstrated that almost one-third of all patients who underwent the first stage of the procedure, did not complete a subsequent reimplantation
PJI and its treatment is associated with a high risk of mortality, especially in patients with older age and higher Charlson comorbidity index (CCI), as shown in our study
While the two-stage exchange arthroplasty can lead to high rates of infection eradication, a third of patients never undergo the second stage of the procedure due to a variety of reasons, including premature mortality, high general morbidity, and low functional demand
Summary
The reported infection eradication rate of two-stage exchange arthroplasty varies in literature between 63% and 100% [4,6]. The majority of these studies focus on the clinical outcomes after successful reimplantation and overlook a substantial number of patients who undergo resection arthroplasty alone and do not complete the second stage of an attempted two-stage exchange arthroplasty [7,8]. Patients with a periprosthetic joint infection (PJI) of the shoulder, who fail to undergo reimplantation in an attempted two-stage exchange seem to be neglected in the current literature. The aim of this study was to assess the clinical course of patients after the first stage in the process of an attempted two-stage exchange for shoulder PJI. The primary outcome measurements analyzed were infection eradication, successful reimplantation, and patient survival
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