Management of periprosthetic shoulder infections with the use of a permanent articulating antibiotic spacer
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Management of periprosthetic shoulder infections (PSIs) still remains challenging. We conducted a retrospective case study to assess the outcomes of definitive articulating antibiotic spacer implantation in a cohort of elderly, low-demanding patients. We hypothesized that in patients with low functional demands seeking pain relief with chronic PSIs, treatment with a definitive articulating antibiotic spacer would lead to satisfying results concerning eradication of the infection, improvement of pain, and improving shoulder function.
Materials and methods
19 patients underwent definitive articulating antibiotic spacer implantation for the treatment of an infected shoulder arthroplasty. Mean age at surgery was 70.2 years. Patients were assessed pre-operatively with functional assessment including Constant-Murley score, and objective examination comprehending ROM, visual analog scale pain score, and patient subjective satisfaction (excellent, good, satisfied, or unsatisfied) score. Radiographs were taken to examine signs of loosening, and change in implant positioning.
At the most recent follow-up, none of the patients had clinical or radiographic signs suggesting recurrent infection. Most patients reported satisfying subjective and objective outcomes. Follow-up examination showed significant improvement of all variables compared to pre-operative values (p < 0.001). Radiographs did not show progressive radiolucent lines or change in the position of the functional spacer. In one case, glenoid osteolysis was reported, which did not affect the clinical outcome.
In selected elderly patients with low functional demands seeking pain relief with infected shoulder arthroplasty, definitive management with a cement spacer is a viable treatment option that helps in eradicating shoulder infection and brings satisfying subjective and objective outcomes.
Level of Evidence
Case series, Level IV.
KeywordsInfected shoulder arthroplasty Periprosthetic shoulder infection Antibiotic spacer Elderly patients
Compliance with ethical standards
Conflict of interest
Each author discloses any financial and personal relationships (e.g., employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, grants or other funding) that might pose a conflict of interest in connection with the submitted article.
Each author certifies that his institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained.
- 5.Loehr J (2010) Surgical management of the infected shoulder arthroplasty. In: Cofield RH, Sperling JW (eds) Revision and complex shoulder arthroplasty. Lippincott Williams and Wilkins, Philadelphia, pp 214–223Google Scholar
- 6.George DA, Volpin A, Scarponi S, Haddad FS, Romanò CL (2016) Does exchange arthroplasty of an infected shoulder prosthesis provide better eradication rate and better functional outcome, compared to a permanent spacer or resection arthroplasty? A systematic review. BMC Musculoskelet Disord 17:52CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Pivec R, Naziri Q, Issa K, Banerjee S, Mont MA. Systematic review comparing static and articulating spacers used for revision of infected total knee arthroplasty. J ArthroplastyGoogle Scholar
- 20.Sperling JW, Kozak TK, Hanssen AD, Cofield RH (2001) Infection after shoulder arthroplasty. Clin Orthop Relat Res (382):206–216Google Scholar