Abstract
Introduction: The most common reported complications with RSA have been instability and infection, with higher rates of infection reported in RSA than anatomic shoulder replacement. This chapter focuses on the application of RSA in the setting of infection, including a review of the literature and outcomes, preferred method of treatment, and key points and pearls. Conclusions: Increased rates of infection in RSA are likely due to a larger subacromial–glenohumeral dead space, limited viable soft tissue coverage due to a lack of rotator cuff integrity, or surgeon experience. Because of the indolent nature of the common shoulder pathogen, Propionibacterium acnes, infection is difficult to identify and surgeons should maintain a high degree of suspicion, even when initial testing does not suggest infection because of the poor sensitivity of common preoperative and intraoperative tests. For the majority of chronic infections, two-stage exchange is currently the most common choice for management. Revision to RSA via a one- or two-stage exchange has shown satisfactory outcomes in regard to reinfection rates. Reimplantation requires appropriate development of all soft tissue planes and adequate soft tissue releases to optimize shoulder range-of-motion and joint stability and depending on bone loss could require bone grafting.
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References
Wall B, Nové-Josserand L, O’Connor DP, Edwards TB, Walch G. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am. 2007;89:1476–85.
Smithers CJ, Young AA, Walch G. Reverse shoulder arthroplasty. Curr Rev Musculoskelet Med. 2011;4:183–90.
Trappey GJ 4th, O’Connor DP, Edwards TB. What are the instability and infection rates after reverse shoulder arthroplasty? Clin Orthop. 2011;469:2505–11.
Favard L, Levigne C, Nerot C, Gerber C, De Wilde L, Mole D. Reverse prostheses in arthropathies with cuff tear: are survivorship and function maintained over time? Clin Orthop. 2011;469:2469–75.
Zumstein MA, Pinedo M, Old J, Boileau P. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elb Surg Am. 2011;20:146–57.
Schairer WW, Zhang AL, Feeley BT. Hospital readmissions after primary shoulder arthroplasty. J Shoulder Elb Surg Am. 2014;23(9):1349–1355.
Farshad M, Gerber C. Reverse total shoulder arthroplasty-from the most to the least common complication. Int Orthop. 2010;34:1075–82.
Cheung EV, Sperling JW, Cofield RH. Infection associated with hematoma formation after shoulder arthroplasty. Clin Orthop. 2008;466:1363–7
Walch G, Bacle G, Lädermann A, Nové-Josserand L, Smithers CJ. Do the indications, results, and complications of reverse shoulder arthroplasty change with surgeon's experience? J Shoulder Elbow Surg 2012 Nov;21(11):1470–7.
Kim SH, Wise BL, Zhang Y, Szabo RM. Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am. 2011;93:2249–54.
Sperling JW, Kozak TK, Hanssen AD, Cofield RH. Infection after shoulder arthroplasty. Clin Orthop. 2001;382:206–216.
Grosso MJ, Frangiamore SJ, Ricchetti ET, Bauer TW, Iannotti JP. Sensitivity of frozen section histology for identifying Propionibacterium acnes infections in revision shoulder arthroplasty. J Bone Joint Surg Am. 2014;96:442–7.
Ricchetti ET. Management of infected shoulder arthroplasty. In: Iannotti JP, Williams GR, Miniaci A, Zuckerman JD, editors. Disorders Shoulder Diagnosis Management, Third edition. Baltimore, MD: Wolters Kluwer/Lippincott Williams & Wilkins; 2014.
Kelly JD 2nd, Zhao JX, Hobgood ER, Norris TR. Clinical results of revision shoulder arthroplasty using the reverse prosthesis. J Shoulder Elb Surg Am. 2012;21:1516–25.
Beekman PDA, Katusic D, Berghs BM, Karelse A, De Wilde L. One-stage revision for patients with a chronically infected reverse total shoulder replacement. J Bone Joint Surg Br. 2010;92:817–22.
Klatte TO, Junghans K, Al-Khateeb H, Rueger JM, Gehrke T, Kendoff D, et al. Single-stage revision for peri-prosthetic shoulder infection: outcomes and results. Bone Joint J. 2013;95-B:391–5.
Hattrup SJ, Renfree KJ. Two-stage shoulder reconstruction for active glenohumeral sepsis. Orthopedics. 2010;33:20.
Coffey MJ, Ely EE, Crosby LA. Treatment of glenohumeral sepsis with a commercially produced antibiotic-impregnated cement spacer. J Shoulder Elb Surg Am. 2010;19:868–73.
Sabesan VJ, Ho JC, Kovacevic D, Iannotti JP. Two-stage reimplantation for treating prosthetic shoulder infections. Clin Orthop. 2011;469:2538–43.
Jawa A, Shi L, O’Brien T, Wells J, Higgins L, Macy J, et al. Prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) use for the treatment of infection after shoulder arthroplasty. J Bone Joint Surg Am. 2011;93:2001–9.
Cuff DJ, Virani NA, Levy J, Frankle MA, Derasari A, Hines B, et al. The treatment of deep shoulder infection and glenohumeral instability with debridement, reverse shoulder arthroplasty and postoperative antibiotics. J Bone Joint Surg Br. 2008;90:336–42.
Ortmaier R, Resch H, Hitzl W, Mayer M, Stundner O, Tauber M. Treatment strategies for infection after reverse shoulder arthroplasty. Eur J Orthop Surg Traumatol. 2013.
Ianotti JP, Frangiamore SJ. Fate of large structural allograft for treatment of severe uncontained glenoid bone deficiency. J Shoulder Elb Surg. 2012;21(6):765–71. doi:10.1016/j.jse.2011.08.069.
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Frangiamore, S.J., Grosso, M.J., Ricchetti, E.T., Iannotti, J.P. (2016). Reverse Total Shoulder Arthroplasty in the Setting of Infection. In: Frankle, M., Marberry, S., Pupello, D. (eds) Reverse Shoulder Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-20840-4_20
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