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Advanced septic arthritis of the shoulder treated by a two-stage arthroplasty.
| Content Provider | Europe PMC |
|---|---|
| Author | Goetti, Patrick Gallusser, Nicolas Antoniadis, Alexander Wernly, Diane Vauclair, Frédéric Borens, Olivier |
| Copyright Year | 2019 |
| Abstract | BACKGROUNDThe usual treatment of septic shoulder arthritis consists of arthroscopic or open lavage and debridement. However, in patients with advanced osteoarthritic changes and/or massive rotator cuff tendon tears, infection eradication can be challenging to achieve and the functional outcome is often not satisfying even after successful infection eradication. In such cases a two-stage approach with initial resection of the native infected articular surfaces, implantation of a cement spacer before final treatment with a total shoulder arthroplasty in a second stage is gaining popularity in recent years with the data in literature however being still limited.AIMTo evaluate the results of a short interval two-stage arthroplasty approach for septic arthritis with concomitant advanced degenerative changes of the shoulder joint.METHODSWe retrospectively included five consecutive patients over a five-year period and evaluated the therapeutic management and the clinical outcome assessed by disability of the arm, shoulder and hand (DASH) score and subjective shoulder value (SSV). All procedures were performed through a deltopectoral approach and consisted in a debridement and synovectomy, articular surface resection and insertion of a custom made antibiotic enriched cement spacer. Shoulder arthroplasty was performed in a second stage.RESULTSMean age was 61 years (range, 47-70 years). Four patients had previous surgeries ahead of the septic arthritis. All patients had a surgical debridement ahead of the index procedure. Mean follow-up was 13 mo (range, 6-24 mo). Persistent microbiological infection was confirmed in all five cases at the time of the first stage of the procedure. The shoulder arthroplasties were performed 6 to 12 wk after insertion of the antibiotic-loaded spacer. There were two hemi and three reverse shoulder arthroplasties. Infection was successfully eradicated in all patients. The clinical outcome was satisfactory with a mean DASH score and SSV of 18.4 points and 70% respectively.CONCLUSIONShort interval two-stage approach for septic shoulder arthritis is an effective treatment option. It should nonetheless be reserved for selected patients with advanced disease in which lavage and debridement have failed. |
| Related Links | https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC6854056&blobtype=pdf |
| Journal | World Journal of Orthopedics [World J Orthop] |
| Volume Number | 10 |
| DOI | 10.5312/wjo.v10.i10.356 |
| PubMed Central reference number | PMC6854056 |
| Issue Number | 10 |
| PubMed reference number | 31754606 |
| e-ISSN | 22185836 |
| Language | English |
| Publisher | Baishideng Publishing Group Inc |
| Publisher Date | 2019-10-18 |
| Access Restriction | Open |
| Rights License | This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved. |
| Subject Keyword | Septic arthritis Shoulder Arthroplasty Spacer Antibiotic Enriched Infection Native joint |
| Content Type | Text |
| Resource Type | Article |
| Subject | Orthopedics and Sports Medicine |
