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Management of periprosthetic infection after reverse shoulder arthroplasty.
Lemmens, Laura; Geelen, Hans; Depypere, Melissa; De Munter, Paul; Verhaegen, Filip; Zimmerli, Werner; Nijs, Stefaan; Debeer, Philippe; Metsemakers, Willem-Jan.
Afiliação
  • Lemmens L; Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium.
  • Geelen H; Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium.
  • Depypere M; Department of Clinical Biology, University Hospitals Leuven, Leuven, Belgium.
  • De Munter P; Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium.
  • Verhaegen F; Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium.
  • Zimmerli W; Interdisciplinary Unit for Orthopaedic Infections, Kantonsspital Baselland, Liestal, Switzerland.
  • Nijs S; Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, University of Leuven, Leuven, Belgium.
  • Debeer P; Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, University of Leuven, Leuven, Belgium.
  • Metsemakers WJ; Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, University of Leuven, Leuven, Belgium. Electronic address: willem-jan.metsemakers@uzleuven.be.
J Shoulder Elbow Surg ; 30(11): 2514-2522, 2021 Nov.
Article em En | MEDLINE | ID: mdl-33895302
BACKGROUND: Periprosthetic shoulder infection (PSI) remains a devastating complication after reverse shoulder arthroplasty (RSA). Currently, scientific data related to the management of PSI are limited, and the optimal strategy and related clinical outcomes remain unclear. Guidelines from the Infectious Diseases Society of America for the management of periprosthetic joint infection are mainly based on data from patients after hip and knee arthroplasty. The aim of this study was to evaluate whether these guidelines are also valid for patients with PSI after RSA. In addition, the functional outcome according to the surgical intervention was assessed. METHODS: An RSA database was retrospectively reviewed to identify infections after primary and revision RSAs, diagnosed between 2004 and 2018. Data collected included age, sex, indication for RSA, causative pathogen, surgical and antimicrobial treatment, functional outcome, and recurrence. RESULTS: Thirty-six patients with a PSI were identified. Surgical treatment was subdivided into débridement and implant retention (DAIR) (n = 6, 17%); 1-stage revision (n = 1, 3%); 2-stage revision (n = 16, 44%); multiple-stage revision (>2 stages) (n = 7, 19%); definitive spacer implantation (n = 2, 6%); and resection arthroplasty (n = 4, 11%). The most common causative pathogens were Staphylococcus epidermidis (n = 11, 31%) and Cutibacterium acnes (n = 9, 25%). Recurrence was diagnosed in 4 patients (11%), all of whom were initially treated with a DAIR approach. The median follow-up period was 36 months (range, 24-132 months). CONCLUSION: PSI is typically caused by low-virulence pathogens, which often are diagnosed with a delay, resulting in chronic infection at the time of surgery. Our results indicate that treatment of patients with chronic PSI with DAIR has a high recurrence rate. In addition, implant exchange (ie, 1- and 2-stage exchange) does not compromise the functional result as compared with implant retention. Thus, patients with chronic PSI should be treated with implant exchange. Future research should further clarify which surgical strategy (ie, 1-stage vs. 2-stage exchange) has a better outcome overall.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções Relacionadas à Prótese / Artroplastia do Ombro Tipo de estudo: Etiology_studies / Guideline / Observational_studies Limite: Humans Idioma: En Revista: J Shoulder Elbow Surg Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Infecções Relacionadas à Prótese / Artroplastia do Ombro Tipo de estudo: Etiology_studies / Guideline / Observational_studies Limite: Humans Idioma: En Revista: J Shoulder Elbow Surg Ano de publicação: 2021 Tipo de documento: Article