What treatment for periprosthetic shoulder infection? Results from a multicentre retrospective series

Value of debridement and irrigation for the treatment of peri-prosthetic infections. A systematic review

Debridement and irrigation has been proposed as a salvage procedure for early post-operative and late acute haematogenous periprosthetic hip and knee infections, however the effective ability of this procedure to avoid recurrent infection is still debated. In this systematic review of the literature we reviewed full-text papers published from 1970 through 2011, that reported the success rate of infection eradication after debridement and irrigation with prosthesis retention for the treatment of early septic complications (within six weeks from surgery) or late acute haematogenous infections after hip or knee prosthesis. In all, 14 original articles, reporting the results of 710 patients were retrieved. The average success rate has been, respectively, 45.9% and 52% after a single or repeated debridement and irrigation procedures, at a mean follow-up of 53.3 months. The methodological limitations of this study and the heterogeneous material in the reviewed papers notwithstanding, this systematic review shows that debridement and irrigation procedure is associated with a rather poor outcome, even in a population of patients selected on the basis of symptoms' duration and patients should be adequately informed prior to undergo this salvage procedure.

Characteristics and outcome of 16 periprosthetic shoulder joint infections

PURPOSE

Shoulder arthroplasties are increasingly performed, but data on periprosthetic joint infections (PJI) in this anatomical position are limited. We retrospectively investigated the characteristics and outcome of shoulder PJI after primary arthroplasty from 1998 to 2010 in a single centre.

METHODS

Periprosthetic joint infection was defined as periprosthetic purulence, presence of sinus tract or microbial growth. A Kaplan-Meier survival method was used to estimate relapse-free survival of prosthesis.

RESULTS

From 1,571 primary shoulder prostheses, we evaluated 16 patients with a PJI at different stages, i.e, early (n = 4), delayed (n = 6) and late (n = 6) infections. The median patient age was 67 (range 53-86) years, and 69 % were females. The most commonly isolated microorganism was Propionibacterium acnes in 38 % of patients (monobacterial in four and polymicrobial in two patients). In 14 of the 16 patients, surgical interventions consisting of debridement and implant retention (6 patients), exchange (7) and explantation (1) were performed. Four patients had a relapse of infection with P. acnes (n = 3) or Bacteroides fragilis (n = 1). The relapse-free survival of the prosthesis was 75 % (95 % confidence interval 46-90 %) after 1 and 2 years, 100 % in six patients following the treatment algorithm for hip and knee PJI and 60 % in 10 patients not followed up. All but one of the relapses were previously treated without exchange of the prosthesis.

CONCLUSIONS

As recommended for hip and knee PJI, we suggest treating shoulder PJI with a low-grade infection by microorganisms such as P. acnes with an exchange of the prosthesis. Cohort studies are needed to verify our results.