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Bilgin E, Tezgel O, Ucan V, Kapıcıoğlu M, Turgut A, Bilsel K. Clinical Outcomes of Two-Stage Implantation in Reverse Shoulder Arthroplasty for Postinfectious End-Stage Glenohumeral Arthritis in Native Shoulders: A Single-Center Cohort Study with a Minimum 2-Year Follow-up. Clin Orthop Surg 2022; 15:272-280. [PMID: 37008966 PMCID: PMC10060767 DOI: 10.4055/cios21275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 04/01/2022] [Accepted: 04/16/2022] [Indexed: 11/06/2022] Open
Abstract
Background Septic arthritis of the shoulder is a rare but devastating condition that may lead to joint destruction. There are few studies and limited outcome data on shoulder arthroplasty for infected native shoulders with end-stage glenohumeral arthritis (GHA). Hence, this study aimed to demonstrate the clinical outcomes of two-stage implantation in reverse shoulder arthroplasty (RSA) using an antibiotic spacer in the first stage for this challenging condition. Methods We conducted a retrospective study on two-stage implantation in RSA in infected shoulders. Patients were diagnosed with end-stage GHA due to primary shoulder sepsis or infection following non-arthroplasty shoulder surgery. Laboratory data, range of motion (ROM), and functional scores including American Shoulder and Elbow Surgeons score, Constant score, and Disabilities of the Arm, Shoulder and Hand score were assessed prior to spacer placement and at the latest follow-up. Furthermore, intraoperative and postoperative complications were recorded. Results In this study, 10 patients with a mean age of 54.8 ± 15.8 years (range, 30-77 years) were included. The mean follow-up period was 37.3 ± 9.1 months (range, 25-56 months). All postoperative ROM measurements and functional scores were improved significantly. Although no reinfection was observed, a total of 5 complications including 2 hematomas, 1 intraoperative humeral fracture, 1 humeral stem loosening, and 1 anterior deltoid dysfunction were observed in 4 patients after a follow-up period of at least 2 years after RSA. Conclusions Two-stage implantation in RSA is an effective method for improving the function and controlling the infection in postinfectious end-stage GHA in native shoulders.
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Affiliation(s)
- Emre Bilgin
- Department of Orthopaedics and Traumatology, Health Science University Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Okan Tezgel
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Vahdet Ucan
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Mehmet Kapıcıoğlu
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
| | - Ali Turgut
- Department of Orthopaedics and Traumatology, Health Science University Tepecik Training and Research Hospital, Izmir, Turkey
| | - Kerem Bilsel
- Department of Orthopaedics and Traumatology, Bezmialem Vakif University Faculty of Medicine, Istanbul, Turkey
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Henry TW, Gutman M, Backal A, Namdari S. The Surgical Treatment of Deep Infection in the Native Shoulder Joint. THE ARCHIVES OF BONE AND JOINT SURGERY 2021; 9:412-417. [PMID: 34423089 DOI: 10.22038/abjs.2020.50100.2484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/03/2020] [Indexed: 11/06/2022]
Abstract
Background The overall clinical picture surrounding native shoulder infections, and, in particular, the associated long-term functional outcomes of treatment are presently underreported. The purpose of this study is to examine the demographics, diagnostic and treatment strategies, and functional outcomes of isolated shoulder joint sepsis treated with surgical irrigation and debridement (I&D). Methods All patients treated with I&D for native shoulder sepsis between 2007 - 2017 were identified. Those without a minimum of one-year follow-up were excluded. Functional outcomes scores, reoperations, and predictors of poor outcome were evaluated. Results Twenty-three patients were included in the final study population. Mean age-adjusted CCI score was 4.1 (SD = 3.4, Range = 0 - 10). Twelve patients (52.2%) were treated with open I&D, while 11 patients (47.8%) were treated arthroscopically. Nine patients (39.1%) required multiple I&Ds (mean total number of I&Ds = 1.7, SD = 1.0, Range: 1 - 4). Five patients (21.7%) had at least one documented reinfection after their initial hospitalization, with the initial recurrence of infection occurring 2 - 15 months after the index procedure. Mean ASES score at final follow-up was 55.3 (SD = 26.7, Range: 5.8 - 98.3) and mean SANE score was 53.3 (SD = 30.6, Range: 0 - 100). Stepwise multiple linear regression modeling identified intravenous drug abuse as the most significant predictor for final ASES score [F(1,18) = 6.12, p = .024, adjusted R2 = .254]. Conclusion Following isolated shoulder joint sepsis, infection clearance and acceptable functional outcomes can be achieved using surgical I&D followed by a course of antibiotics, but outcomes are variable.
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Affiliation(s)
- Tyler W Henry
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael Gutman
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Amy Backal
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Surena Namdari
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.,Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
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Crum RJ, de SA DL, Su FL, Lesniak BP, Lin A. Decreased complication profile and improved clinical outcomes of primary reverse total shoulder arthroplasty after 2010: A systematic review. Shoulder Elbow 2021; 13:154-167. [PMID: 33897847 PMCID: PMC8039761 DOI: 10.1177/1758573219852977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/31/2019] [Accepted: 04/29/2019] [Indexed: 01/23/2023]
Abstract
The purpose of this review was to update the complication profile of reverse total shoulder arthroplasty (rTSA) post-2010, given greater procedural familiarity, improved learning curves, enhanced implant designs, and increased attention to the nuances of patient selection. Three electronic databases were searched and screened in duplicate from 1 January 2010 to 16 December 2018 based on predetermined criteria. Twenty-two studies examining 1455 patients (26% male; mean age: 73.4 ± 3.6; mean follow-up: 23.4 ± 14.3 months) were reviewed. Post-operative motion ranged a mean 122.4° ± 11.5° flexion, 109° ± 19.4° abduction, and 33° ± 11.2°/41° ± 5° external/internal rotation. Post-operative mean Constant score was 58.9 ± 10.1, American Shoulder Elbow Surgeon score was 73.4 ± 6.1, Simple Shoulder Test score was 63.5 ± 6.5, and a Visual Analog Scale pain score was 1.6 ± 0.9. The overall complication rate was 18.2% and major complication rate was 15.4%. Compared to pre-2010, the overall complication rate of 18.2% is lower than previous rates of 19%-68%, with the rate of "major" complications dropping three-fold from 15.4% to 4.6%. The data suggest that rTSA is a safe and efficacious alternative to aTSA and HA, and the "stale" nature of previous complication profiles are points fundamental to perioperative discussions surrounding rTSA.
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Affiliation(s)
- Raphael J Crum
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA,Raphael J Crum, University of Pittsburgh
School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15213, USA.
| | | | - Favian L Su
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Bryson P Lesniak
- Center for Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Albert Lin
- Center for Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Kriechling P, Bouaicha S, Andronic O, Uçkay I, Bock D, Wieser K. Limited improvement and high rate of complication in patients undergoing reverse total shoulder arthroplasty for previous native shoulder infection. J Shoulder Elbow Surg 2021; 30:34-39. [PMID: 32807379 DOI: 10.1016/j.jse.2020.04.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND The outcomes of reverse total shoulder arthroplasty (RTSA) surgery for the sequelae of former septic native joint shoulder arthritis are unknown but might be inferior to patients without prior bacterial arthritis. METHODS We performed a single-center case-control study embedded in our prospective RTSA cohort. We matched all patients with prior infections in a 1:1 ratio with patients who underwent RTSA for other indications. The matching variables were indication for surgery, age, sex, dominant/nondominant shoulder, and body mass index. We evaluated outcomes by Constant score and active function. RESULTS Among 1249 patients in the RTSA cohort, 14 were operated for sequelae of previous native shoulder joint infections. Although both groups significantly improved from preoperative to postoperative values, the outcome of postinfectious patients was clearly inferior in comparison with the control group (absolute [38 ± 17 vs. 75 ± 8, P < .01], relative Constant score [47 ± 19 vs. 88 ± 9, P < .01], Constant pain score [11.0 ± 3.1 vs. 14.3 ± 1.3, P < .01], subjective shoulder value [43 ± 26 vs. 85 ± 10, P < .01], abduction [70 ± 43 vs. 148 ± 29°, P = .001], and elevation [82 ± 49° to 131 ± 16°, P = .02]). Moreover, in the postinfectious group, overall surgical complications occurred in 36%, with the need for revision in 21%. There was, however, no recurrence of infection in any of the patients' shoulders. CONCLUSION RTSA for end-stage postinfectious joint disease is associated with a high number of complications and reoperations. Clinical outcomes are inferior to those without past infection.
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Affiliation(s)
- Philipp Kriechling
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland.
| | - Samy Bouaicha
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Octavian Andronic
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Ilker Uçkay
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland; Department of Infectiology, Balgrist University Hospital, Zürich, Switzerland
| | - David Bock
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
| | - Karl Wieser
- Department of Orthopedics, Balgrist University Hospital, Zürich, Switzerland
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Kim JY, Rhee YG, Rhee SM. Clinical Outcomes after Reverse Total Shoulder Arthroplasty According to Primary Diagnosis. Clin Orthop Surg 2020; 12:521-528. [PMID: 33274030 PMCID: PMC7683196 DOI: 10.4055/cios19164] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/12/2020] [Indexed: 12/16/2022] Open
Abstract
Background To compare the clinical outcomes of reverse total shoulder arthroplasty (RTSA) according to the primary diagnosis. Methods In 98 shoulders (97 patients), RTSA was performed for cuff tear arthropathy (45), massive rotator cuff tear without glenohumeral arthritis (31), posttraumatic arthritis (9), primary osteoarthritis (6), rheumatoid arthritis (4), and arthritis due to infection sequelae (3). The average age of the patients at surgery was 68.9 years (range, 46-84 years). The mean follow-up duration was 48.4 months (range, 24-85 months). Results In the overall series, the mean subjective pain score (visual analog scale) during motion decreased from 5.2 preoperatively to 1.8 at 2 years of follow-up. There were significant improvements in active forward flexion (preoperatively 51.5° to 121.8° at 2 years of follow-up). The average Constant score improved from 35.4 points to 57.8 points and UCLA score improved from 13.4 points to 28.8 points. The Constant score and UCLA score were 60.8 and 31.0 points, respectively, in patients with rheumatoid arthritis. The Constant score and UCLA score were 58.4 and 29.1 points, respectively, in patients with cuff tear disease and 55.7 and 27.7 points, respectively, in patients with posttraumatic arthritis. Patients' subjective satisfaction was 86.8 points in the overall series; highest in the patients with arthritis by infection sequelae (96.7 points) and lowest in the patients with posttraumatic arthritis (82.2 points). In terms of complications, there were 17 cases (17.3%) of scapular notching and 2 patients with suprascapular nerve irritation symptom, but no patients with permanent neuropathy. Conclusions The range of forward flexion and abduction motion, pain relief, and functionality were improved after RTSA in not only patients with cuff tear disease but also those with other arthritic diseases. There was no difference in the clinical outcomes of RTSA between patients with cuff tear disease and those with other arthritic diseases.
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Affiliation(s)
- Jung Youn Kim
- Department of Orthopaedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yong Girl Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Sung-Min Rhee
- Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, Kyung Hee University College of Medicine, Seoul, Korea
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