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Hollier-Larousse B, Hardy A, El Sayed F, Roux AL, Ménigaux C, Bauer T, Werthel JD. Single-stage revision for total shoulder arthroplasty infection. Results at a minimum 2 years follow-up. Orthop Traumatol Surg Res 2024:103881. [PMID: 38582223 DOI: 10.1016/j.otsr.2024.103881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 10/10/2023] [Accepted: 12/22/2023] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Similar to the management of periprosthetic joint infections of the lower limb, one-stage revision in total shoulder arthroplasty (TSA) infections is an option that has been highlighted in scientific publications since the early 2010s. However, there are only a few studies which validate this treatment and determine its scope of application in relation to two-stage treatment. HYPOTHESIS Single-stage revision for infected TSA is a reliable treatment allowing good infection control and satisfactory functional results. METHODS This single-center retrospective series of 34 consecutive patients operated on between 2014 and 2020 for a one-stage prosthetic revision was evaluated at a minimum of 2 years of follow-up. All of the patients included underwent revision shoulder arthroplasty during this period with the diagnosis of infection confirmed by microbiological analysis of surgical samples. Patients who did not benefit from a bipolar revision were excluded. All patients were followed at least 2 years after the intervention. Clinically suspected recurrence of infection was confirmed by a periprosthetic sample under radiographic guidance. Functional clinical outcomes as well as mechanical complications were also reported. RESULTS The average follow-up was 40.4 months (24-102±21.6). A septic recurrence was observed in three patients (8.8%). A mechanical complication was present in four patients (14.7%), and three (11.8%) required at least one surgical revision. The mean Constant-Murley score at the last follow-up was 49 (42-57±21.83). DISCUSSION Single-stage revision for shoulder periprosthetic joint infection results in a success rate of 91.2% with satisfactory functional results after more than 2 years of follow-up. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
| | - Alexandre Hardy
- Service d'orthopédie traumatologique, AP-HP, CHU Ambroise-Paré, Boulogne Billancourt, France
| | - Faten El Sayed
- Infection et Inflammation, université Paris-Saclay, UVSQ, Inserm, Montigny-Le-Bretonneux, France; Microbiology Department, GHU Paris-Saclay, hôpital Ambroise-Paré, AP-HP, Boulogne Billancourt, France
| | - Anne-Laure Roux
- Infection et Inflammation, université Paris-Saclay, UVSQ, Inserm, Montigny-Le-Bretonneux, France
| | - Christophe Ménigaux
- Service d'orthopédie traumatologique, AP-HP, CHU Ambroise-Paré, Boulogne Billancourt, France
| | - Thomas Bauer
- Service d'orthopédie traumatologique, AP-HP, CHU Ambroise-Paré, Boulogne Billancourt, France
| | - Jean-David Werthel
- Service d'orthopédie traumatologique, AP-HP, CHU Ambroise-Paré, Boulogne Billancourt, France
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Rodrigues-Lopes R, Silva F, Torres J. Periprosthetic shoulder infection management: one-stage should be the way: a systematic review and meta-analysis. J Shoulder Elbow Surg 2024; 33:722-737. [PMID: 37839627 DOI: 10.1016/j.jse.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/29/2023] [Accepted: 09/03/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND There is still no consensus among surgeons on whether to perform a 1- or 2-stage surgical revision in infected shoulder arthroplasties. The aim of this systematic review and meta-analysis is to rigorously synthesize published studies evaluating the clinical outcomes, recurrence of infection, and other clinical complications in order to discuss which is the best strategy for treating periprosthetic joint infection after shoulder arthroplasty. METHODS Upon research using the PubMed, Scopus, and Web of Science databases, in November 2022, studies that presented 1- or 2-stage surgical revision as a treatment for periprosthetic joint infection after shoulder arthroplasty and assessed the reinfection rate on these patients, as well as other clinical outcomes, with a minimum follow-up of 12 months, were included. Study quality was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) score. Reinfection and complication rates were extracted, and pooled estimates were calculated using the random-effect model. RESULTS After careful screening, 44 studies were included, 5 reporting on 1-stage and 30 on 2-stage revisions and 9 assessing both strategies. A total of 185 shoulders were reported in 1-stage revision studies, whereas 526 shoulders were reported in 2-stage revision studies. The overall pooled random-effects reinfection rate was 6.68% (95% confidence interval [CI]: 3.76-10.13), with low heterogeneity (I2 = 28%, P = .03). One-stage revision showed a reinfection rate of 1.14% (95% CI: 0.00-4.88), whereas 2-stage revision analysis revealed a reinfection rate of 8.81% (95% CI: 4.96-13.33). There were significant statistical differences between 1- and 2-stage reinfection rates (P = .04). The overall pooled rate for other clinical complications was 16.76% (95% CI: 9.49-25.15), with high heterogeneity (I2 = 70%, P < .01). One-stage revision had a complication rate of 6.11% (95% CI: 1.58-12.39), whereas the 2-stage revision complication rate was 21.26% (95% CI: 11.51-32.54). This difference was statistically significant (P = .03). CONCLUSIONS This is the first systematic review and meta-analysis showing significant statistical differences between 1- and 2-stage surgical revision in infected shoulder arthroplasties. Provided the right conditions exist, 1-stage revision shows better results in infection control, with lower clinical complications and possible better clinical outcomes.
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Affiliation(s)
| | - Fábia Silva
- Department of Orthopaedics and Traumatology, University Hospital Center of São João, Porto, Portugal
| | - João Torres
- Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Orthopaedics and Traumatology, University Hospital Center of São João, Porto, Portugal
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Erivan R, Villatte G, Haverlan A, Roullet CA, Ouchchane L, Descamps S, Boisgard S. Does a sign restricting operating room access reduce staff traffic in the surgical department? Orthop Traumatol Surg Res 2024:103843. [PMID: 38387645 DOI: 10.1016/j.otsr.2024.103843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/29/2023] [Accepted: 01/11/2024] [Indexed: 02/24/2024]
Abstract
INTRODUCTION Infections following orthopedic surgery are rare but difficult to treat. Among the prevention measures reviewed during the Musculoskeletal Infection Society's (MSIS) 2023 international consensus meeting, the only strategy to obtain 100% agreement was the control of traffic in and out of the operating room (OR). Although this recommendation makes good sense, to our knowledge, it has not been previously investigated in a comparative study. We, therefore, conducted a prospective, observational, before-and-after study of the implementation of an informational sign designed to limit traffic in and out of the OR to (1) determine its impact on door openings and the number of people present during orthopedic surgery and (2) assess the risk of surgical site infection after the institution of this sign. HYPOTHESIS This type of sign reduces the number of door openings. MATERIALS AND METHODS This prospective, observational study included all patients operated on in one of our ORs over a 6-week period. The number of entrances and exits from the OR and how long the doors were kept open were recorded during the entire study period. After 3 weeks, an informational sign was posted on the OR doors warning people that unnecessary traffic in and out of the OR increases the risk of infection. During this period, we also recorded the type of procedure, operative time, the number of people in the OR at the time of the incision, and the number of entrances and exits. Patients underwent a follow-up at 2 years to check for postoperative infection. The primary endpoint was the number of OR door openings, and the secondary endpoint was the number of infections at 2 years postoperatively. RESULTS The 2 groups (before and after the implementation of the sign) were homogeneous. The average total number of door openings for all ORs was 28.9±19.6 [2-90]. In the no sign group, it was 33.3±20.9 [3-90], and in the sign group, it was 21.0±14.7 [2-50] (p=0.011). The maximum number of people in the OR at one time was 8.32±1.84 [4-12] in the no sign group and 8.44±1.98 [5-12] in the sign group (p=0.8). There were 3 postoperative infections at the 2-year follow-up, all occurring in the no sign group. The infection rate was 6.4% (3/47) in the no sign group versus 0% (0/25) in the sign group (p=0.197). DISCUSSION Our prospective study demonstrated a simple strategy to reduce the number of entrances and exits, the number of people in the OR, and potentially the risk of surgery-related infection. Another larger-scale study is needed to assess the exact impact of this type of sign, particularly on the risk of infection. LEVEL OF EVIDENCE III; prospective non-randomized comparative study.
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Affiliation(s)
- Roger Erivan
- CNRS, SIGMA Clermont, ICCF, CHU de Clermont-Ferrand, université Clermont Auvergne, 63000 Clermont-Ferrand, France.
| | - Guillaume Villatte
- CNRS, SIGMA Clermont, ICCF, CHU de Clermont-Ferrand, université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Arthur Haverlan
- CHU de Clermont-Ferrand, université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Claude Alain Roullet
- CHU de Clermont-Ferrand, université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Lemlih Ouchchane
- CNRS, SIGMA Clermont, institut Pascal, université Clermont Auvergne, 63000 Clermont-Ferrand, France; Unité de biostatistique-informatique médicale, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Stéphane Descamps
- CNRS, SIGMA Clermont, ICCF, CHU de Clermont-Ferrand, université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Stéphane Boisgard
- CNRS, SIGMA Clermont, ICCF, CHU de Clermont-Ferrand, université Clermont Auvergne, 63000 Clermont-Ferrand, France
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Saccomanno MF, Lädermann A, Collin P. Two-Stage Exchange Arthroplasty for Periprosthetic Reverse Shoulder Arthroplasty Infection Provides Comparable Functional Outcomes to Primary Reverse Shoulder Arthroplasty. J Clin Med 2024; 13:904. [PMID: 38337598 PMCID: PMC10856729 DOI: 10.3390/jcm13030904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/15/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
This study aimed to compare functional outcomes after two-stage revision reverse shoulder arthroplasty (RSA) for periprosthetic joint infection (PJI) with the results of primary RSA. Patients affected by PJI and treated by means of two-stage revision RSA were 1:1 matched with a group of patients who were treated electively with RSA without developing any complications. Out of 1477 RSAs performed between 2009 and 2021, 16 patients developed a PJI. Each matched cohort comprised 16 patients (3 females, 13 males). The mean age was 69.13 ± 5.43 years old in the PJI group and 70.28 ± 5.04 (p = 0.543) in the matched cohort. The mean follow-up was 41.23 ± 26.9 months in the PJI group and 28.5 ± 20.2 (p = 0.142) in the matched group. Only one patient showed recurrent PJI five years after revision RSA. Comparison between the PJI patients and matched patients did not show any significant differences at the latest follow-up, nor for subjective shoulder value (SSV) (p = 0.101) or Constant score (p = 0.134). Two-stage exchange RSA for PJI allows for appropriate control of the disease and good functional outcomes. Comparison with an age- and sex-matched cohort of uninfected patients showed no significant differences, thus confirming the idea that revision surgeries may lead to satisfactory functional outcomes, as expected after primary surgery.
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Affiliation(s)
- Maristella Francesca Saccomanno
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy;
- Department of Bone and Joint Surgery, Spedali Civili, 25123 Brescia, Italy
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, Hôpital de La Tour, Rue J.-D. Maillard 3, 1217 Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211 Geneva, Switzerland
| | - Philippe Collin
- CHP Saint-Gregoire, 6 Boulevard de la Boutière, 35760 Saint-Grégoire, France;
- Clinique Victor Hugo, 5 Bis Rue du Dôme, 75016 Paris, France
- American Hospital of Paris, 55 Boulevard du Château, 92200 Neuilly-sur-Seine, France
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El Amiri L, Clavert P, Gaudias J, Klein S, Rondé Oustau C, Antoni M. High infection control rate after systematic one-stage procedure for shoulder arthroplasty chronic infection. INTERNATIONAL ORTHOPAEDICS 2023; 47:2809-2826. [PMID: 37612523 DOI: 10.1007/s00264-023-05927-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE The two stage revision procedure is the gold standard surgical technique in chronic shoulder periprosthetic joint infection (PJI). Series of one stage revision have been published with similar outcomes but with preoperative selection of patients. The aim of this work was to report the outcomes (infection eradication, functional, and radiographic) after systematic one stage revision, without preoperative selection of patients, in chronic shoulder PJI. METHODS This was a retrospective monocentric study including 40 patients (14 women and 26 men) with a diagnosis of periprosthetic joint infection after a shoulder arthroplasty. A one stage shoulder prosthesis revision was performed in all patients, for a PJI evolving for more than three weeks, without preoperative patient selection. The primary endpoint was the absence of signs of persistent infection at a minimum follow-up of two years. Secondary endpoints were clinical and radiological outcomes. RESULTS At the last follow-up, 36/40 patients had no recurrence of infection after the one stage revision, i.e., 90% of our series. In 45% (18/40) of the cases, the microbial organism was not known at the time of the one stage revision. Cutibacterium acnes was the most frequent pathogen, found in 67.5% (27/40) of the patients. The infection was polymicrobial in 40% (16/40) of the cases. At last follow-up, mean absolute Constant score was 48.4% (16-93) and weighted score was 65.5% (22-100), and satisfaction was evaluated by the patients as excellent or good in 75% (30/40). About 20% (8/40) of the patients had a postoperative complication. CONCLUSION A one stage revision procedure, combined with appropriate antibiotic therapy, made it possible to eradicate the PJI in 90% of the shoulders in our series with satisfactory functional outcomes.
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Affiliation(s)
- Laëla El Amiri
- Shoulder and Elbow Surgery Department, Hautepierre Hospital 2 - CHU Strasbourg, Avenue Molière, 67000, Strasbourg, France
| | - Philippe Clavert
- Shoulder and Elbow Surgery Department, Hautepierre Hospital 2 - CHU Strasbourg, Avenue Molière, 67000, Strasbourg, France
| | - Jeannot Gaudias
- Department of Orthopedic Septic Surgery, University Hospitals of Strasbourg, 1 place de l'hôpital, 67000, Strasbourg, France
| | - Stéphane Klein
- Department of Orthopedic Septic Surgery, University Hospitals of Strasbourg, 1 place de l'hôpital, 67000, Strasbourg, France
| | - Cécile Rondé Oustau
- Department of Orthopedic Septic Surgery, University Hospitals of Strasbourg, 1 place de l'hôpital, 67000, Strasbourg, France
| | - Maxime Antoni
- Shoulder and Elbow Surgery Department, Hautepierre Hospital 2 - CHU Strasbourg, Avenue Molière, 67000, Strasbourg, France.
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Bastard C, Aïm F, Meyssonnier V, Kerroumi Y, Marion B, Zeller V, Marmor S. One-stage revision for infected shoulder arthroplasty: prospective, observational study of 37 patients. JSES Int 2023; 7:2433-2439. [PMID: 37969534 PMCID: PMC10638573 DOI: 10.1016/j.jseint.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background Periprosthetic joint infection is a severe complication of joint replacement surgery. Thus two-stage exchange remains the gold standard, one-stage exchange is now widely recommended. We hypothesized that, for patients with chronic periprosthetic shoulder infection (PSI), treatment with a one-stage exchange would be an effective approach to eradicate infection, relieve pain, and restore function to the involved shoulder. Materials and methods This monocenter cohort study in a Bone and Joint Infection Referral Center (11/2003-05/2020) included all patients with confirmed PSI treated by one-stage revision. Data were extracted from the prospective database, including demographics, infection characteristics, and functional evaluations (range of motion and Constant Score at admission and last follow-up). The primary outcome was the 2-year reinfection-free rate. Results We included 37 patients. The refection-free rate was 5%. The most commonly isolated pathogen was Cutibacterium acnes (68%), isolated alone (15 patients, 41%) or as polymicrobial infections (10 patients, 27%). The Constant Score increased significantly from 24 to 53 (P = .001). Range of motion (forward elevation, abduction) was also significantly improved after surgery. Mean active forward elevation increased significantly by 45° from 60° to 105° postoperatively (P < .001), mean abduction increased by 42° from 55° to 97° (P < .001). Discussion Results from our prospective cohort-extracted series suggest that one-stage revision is a reliable treatment with a low infection recurrence rate. Improved functional outcomes can be achieved with one-stage exchange. Our patients' overall functional results were similar to those previously reported for one-stage revision and better than those reported after two-stage exchange. Patients with multiple previous surgeries seem to have worse functional outcomes than the subgroup without surgery before the index arthroplasty. Conclusions Our results and literature search findings suggest that one-stage revisions effectively eradicate PSIs, with good functional outcomes.
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Affiliation(s)
- Claire Bastard
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Florence Aïm
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Vanina Meyssonnier
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
- Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Younes Kerroumi
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Blandine Marion
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
- Service de Médecine Interne et Infectiologie, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
| | - Simon Marmor
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses–Croix Saint-Simon, Paris, France
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Lo EY, Ouseph A, Badejo M, Lund J, Bettacchi C, Garofalo R, Krishnan SG. Success of staged revision reverse total shoulder arthroplasty in eradication of periprosthetic joint infection. J Shoulder Elbow Surg 2023; 32:625-635. [PMID: 36243299 DOI: 10.1016/j.jse.2022.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Management of periprosthetic joint infection (PJI) in shoulder arthroplasty remains a challenge, with no established gold standard treatment. This study presents the unique experience of a high-volume single-surgeon, single-institution approach on staged revision reverse total shoulder arthroplasty (RTSA) for infection. The authors theorize that staged revision RTSA is an effective treatment for PJI. MATERIALS AND METHODS Between 2013 and 2018, 38 patients underwent a staged RTSA for treatment of PJI. Patient histories were collected and classified using Cierny-Mader classification. Infection workup for all patients included radiographs, laboratory indices, and computed tomographic aspiration arthrogram. PJI was identified based on high clinical and radiographic suspicion, elevated serologic markers, and/or aspirate culture results per 2018 International Consensus Meeting Shoulder guidelines on Orthopedic Infections. All patients underwent first stage with implant removal, irrigation and débridement, and antibiotic spacer placement. Next, intravenous antibiotics were administered by infectious disease consultants for a minimum of 6 weeks. Infection workup was then repeated and, if normalized, final-stage revision commenced with antibiotic spacer removal and revision to RTSA. If indices were persistently abnormal, an additional stage of débridement and spacer placement procedure was performed. Treatment failure was defined as recurrent periprosthetic infection after final prosthesis implantation or persistently elevated indices despite adequate débridement and spacer placement. RESULTS Mean age of the cohort was 68 (standard deviation [SD] 8.9) years and mean follow-up was 33 (SD 14) months with 34 Cierny-Mader C hosts and 4 B hosts. Patients underwent a mean of 2 (SD 1.1) previous surgeries. The staged revision protocol was successful in 34 (89.5%) patients for management of PJI. Four patients (10.5%) were considered failures with recurrent infections at a mean of 13 months (range 2-26 months) after the final RTSA implantation and underwent repeat staged revisions. Of the 34 patients who had successful infection eradication, 31 had 2-stage treatment and 3 had to undergo 3 stages. There were no treatment-associated mortalities and 10 major complications (26%), including permanent neuropathy, instability, and periprosthetic fractures. The most common cultured microorganism was Cutibacterium acnes (18%), with no polymicrobial infections detected. DISCUSSION Although there are multiple treatment options for PJI management, staged revision remains an effective means of treatment. Although there were several patients who required an additional stage of treatment, and a significant complication rate, staged revision RTSA proved successful in the ultimate eradication of the PJI.
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Affiliation(s)
- Eddie Y Lo
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA; The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA.
| | - Alvin Ouseph
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA; The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA
| | | | - Julia Lund
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA; The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA
| | - Christopher Bettacchi
- North Texas Infectious Diseases Consultants, Baylor University Medical Center, Dallas, TX, USA
| | - Raffaele Garofalo
- Upper Limb Unit, F Miulli Hospital, Acquaviva Delle Fonti, BA, Italy
| | - Sumant G Krishnan
- The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA; The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA
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Faria G, Flood C, Muhammed AR, Narang A, Masood Q, Bakti N, Singh B. Prosthetic joint infections of the shoulder: A review of the recent literature. J Orthop 2023; 36:106-113. [PMID: 36685110 PMCID: PMC9851837 DOI: 10.1016/j.jor.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/17/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Shoulder arthroplasty is a common treatment for shoulder arthritis. Prosthetic joint infection of the shoulder (PJIS) is a debilitating complication to the patient and the healthcare system. Incidence of infection is 0.98-5% for primary arthroplasty. The mean hospital cost for two-stage revision was approximately $35,824. The aim of this paper is to review the recent literature and collate the latest evidence to aid diagnosis and treatment of this serious complication. Methods A literature review was performed using PubMed and Google Scholar databases. A search strategy was adopted using the keywords: 'infection' AND 'shoulder arthroplasty' OR 'total shoulder arthroplasty'OR 'TSA' OR 'reverse shoulder arthroplasty' OR 'RSA' OR 'rTSA'. This initial search resulted in 349 articles. A PRISMA flowchart process was followed. Duplicates were removed, screening was performed and the resulting full texts were analysed and further excluded, leaving 46 articles suitable for inclusion. A PICO search strategy was also used. Results and interpretation Risk factors for PJIS include procedure type, trauma indications and patient factors.The organism commonly isolated is Cutebacterium acnes, which makes diagnosis challenging due to its indolent nature. Investigations include biochemical tests, synovial aspirate, tissue cultures and radiological examinations.Treatment depends on the depth of the infection and the patient requirements. Medical treatment with antibiotics to local debridement, cement spacer and revision arthroplasty have all been described in the literature. A multidisciplinary decision is made on the microbiological evidence and patient factors. Conclusion PJIS is a rare but potentially devastating complication of shoulder arthroplasty and diagnosis is often challenging. There has been much research performed recently, providing more evidence on how to optimise management.
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Affiliation(s)
- Giles Faria
- Darent Valley Hospital, Darenth Wood Rd, Dartford, Kent, DA2 8DA, United Kingdom
| | - Catherine Flood
- Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, United Kingdom
| | | | - Ashish Narang
- Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, United Kingdom
| | - Qazi Masood
- Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, United Kingdom
| | - Nik Bakti
- Darent Valley Hospital, Darenth Wood Rd, Dartford, Kent, DA2 8DA, United Kingdom
| | - Bijayendra Singh
- Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, United Kingdom
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Shen J, Kan P. Comment on: "One- or two-stage exchange for periprosthetic shoulder infection: Systematic review and meta-analysis" of F. Aim, B. Marion, Y. Kerroumi, V. Meyssonnier, S. Marmor published in Orthop Traumatol Surg Res. 2020;106:5-15. Orthop Traumatol Surg Res 2022; 108:103365. [PMID: 35840045 DOI: 10.1016/j.otsr.2022.103365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/07/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Jie Shen
- Department of Orthopedics, The Affiliated Jiangyin Hospital of Nantong University, 214400 Jiangyin, Jiangsu, P.R. China
| | - Peng Kan
- Department of Orthopedics, The Affiliated Jiangyin Hospital of Nantong University, 214400 Jiangyin, Jiangsu, P.R. China.
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Sakek F, Haight H, Tuphé P, Regas I, Adam A, Rochet S, Lascar T, Obert L, Loisel F. Assessment of intraoperative bleeding in reverse shoulder arthroplasty - with or without a stem. Orthop Traumatol Surg Res 2022; 108:103245. [PMID: 35158104 DOI: 10.1016/j.otsr.2022.103245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 11/18/2021] [Accepted: 11/26/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The functional results of stemless reverse shoulder prostheses are similar to those with stems. However, the operative time and the bleeding appear less significant because of the absence of humeral reaming. To date, the data amongst the literature regarding this subject is limited. Thus, we report a retrospective evaluation on these 2 types of prostheses by assessing their respective intraoperative blood loss. HYPOTHESIS Reverse shoulder arthroplasty without a stem leads to less blood loss, compared to arthroplasty with a stem. MATERIALS AND METHODS Twenty-three patients underwent an operation for a stemless prosthesis, while 37 patients had a prosthesis with a stem. The hemoglobin was measured preoperatively, as well as postoperatively. Drainage of the operative site was maintained for two to three days. In the stem group, the preoperative hemoglobin was 14g/dL (11.7-16.6), while it was 13.1g/dL (11-15.8) in the stemless group. RESULTS The intraoperative bleeding reached 223cm3 (80-530), with an operative duration of 81minutes (40-110) in the stemless group, compared to 260cm3 (50-1000) and 92minutes (33-110) in the stem group. On the first day postoperatively, 333cm3 (20-570) of blood had been collected by drainage for the stemless group, compared to 279cm3 (40-550) in the stem group. The amount decreased the second day, with 139cm3 (20-510) and 129cm3 (0-750) respectively. There was no difference between the two groups regarding the postoperative hemoglobin level (11g/dL). DISCUSSION There is no significant difference concerning the blood loss between reverse shoulder replacements with and without stems. LEVEL OF EVIDENCE III Retrospective case control study.
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Affiliation(s)
- Fiona Sakek
- CHU Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France.
| | - Harrison Haight
- CHU Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - Pierre Tuphé
- CHU Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - Inès Regas
- CHU Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - Antoine Adam
- CHU Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - Séverin Rochet
- CHU Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | | | - Laurent Obert
- CHU Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
| | - François Loisel
- CHU Besançon, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
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Contreras ES, Frantz TL, Bishop JY, Cvetanovich GL. Periprosthetic Infection After Reverse Shoulder Arthroplasty: a Review. Curr Rev Musculoskelet Med 2020; 13:757-768. [PMID: 32827305 PMCID: PMC7661562 DOI: 10.1007/s12178-020-09670-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Periprosthetic infection is a relatively rare but potentially devastating complication after shoulder arthroplasty. The purpose of this article is to review the incidence, diagnosis, prevention, and management of periprosthetic infections after reverse shoulder arthroplasty, with a focus on literature published within the last 5 years. RECENT FINDINGS The 2018 International Consensus Meeting on Musculoskeletal Infection provides us with a framework for the diagnosis and management of periprosthetic infections after shoulder arthroplasty. Reverse shoulder arthroplasty has a higher reported rate of infection compared with anatomic total shoulder arthroplasty. Our current diagnostic tests do not appear to be as sensitive when compared with the hip and knee literature. Similar success has been reported with single and two-stage revision protocols, although prospective comparative data are lacking. The significance of unexpected positive cultures during revision arthroplasty remains unclear. We report current diagnostic and therapeutic options for periprosthetic infection after reverse shoulder arthroplasty. Much of the current literature does not distinguish between anatomic and reverse shoulder arthroplasty. Further high-level studies are warranted to refine these definitions and guide management.
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Affiliation(s)
- Erik S. Contreras
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Travis L. Frantz
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Julie Y. Bishop
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Gregory L. Cvetanovich
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
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Aïm F, Marion B, Kerroumi Y, Meyssonnier V, Marmor S. Reply to the letter by Christophe Nich. Orthop Traumatol Surg Res 2020; 106:987-989. [PMID: 32665202 DOI: 10.1016/j.otsr.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/12/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Florence Aïm
- Centre de référence des infections ostéo-articulaires, groupe hospitalier Diaconnesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France; Service de chirurgie orthopédique, groupe hospitalier Diaconnesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France.
| | - Blandine Marion
- Centre de référence des infections ostéo-articulaires, groupe hospitalier Diaconnesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France; Service de chirurgie orthopédique, groupe hospitalier Diaconnesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Younes Kerroumi
- Centre de référence des infections ostéo-articulaires, groupe hospitalier Diaconnesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Vanina Meyssonnier
- Centre de référence des infections ostéo-articulaires, groupe hospitalier Diaconnesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
| | - Simon Marmor
- Centre de référence des infections ostéo-articulaires, groupe hospitalier Diaconnesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France; Service de chirurgie orthopédique, groupe hospitalier Diaconnesses Croix Saint-Simon, 125, rue d'Avron, 75020 Paris, France
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Nich C. Comments on: Aïm et al.: « One- or two-stage exchange for periprosthetic shoulder infection: Systematic review and meta-analysis » of F Aim, B Marion, Y Kerroumi, V Meyssonnier, S Marmor published in Orthop Traumatol Surg Res 2020;106:5-15. Orthop Traumatol Surg Res 2020; 106:985. [PMID: 32660782 DOI: 10.1016/j.otsr.2020.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 03/24/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Christophe Nich
- Universite de Nantes, Orthopedics and Trauma Department, University Hospital Hôtel-Dieu, CHU de Nantes, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
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