Surgical Treatment of Infected Shoulder Arthroplasty. A Systematic Review

Overview

Journal Int Orthop

Specialty Orthopedics

Date 2017 Jan 27

PMID 28124103

Citations 14

Authors

Giulio Maria Marcheggiani Muccioli

Gazi Huri

Alberto Grassi

Tommaso Roberti di Sarsina

Giuseppe Carbone

Enrico Guerra

Edward G McFarland

Mahmut N Doral

Maurilio Marcacci

Stefano Zaffagnini

Affiliations

Soon will be listed here.

Abstract

Purpose: To investigate the best surgical management of infected shoulder arthroplasty.

Methods: A literature review from 1996 to 2016 identified 15 level IV studies that met inclusion criteria. Persistent infection (PI) was considered as treatment failure. Success was regarded as the absence of symptomatic PI without necessity for further treatment. Surgical outcomes were reported according to the mean weighted Constant and Murley score (CMS) for each treatment group.

Results: Overall, 287 patients (146 males/141 females) were identified at a mean follow-up of 50.4 (range 32-99.6) months. The PI in the whole population was 11.5%. The pooled mean CMS, available for 218 patients, was 39 ± 13. Twenty-seven patients (9.4%) were treated with debridement (PI 29.6%, CMS 41 ± 12), 52 patients (18.1%) with resection arthroplasty (PI 11.5%, CMS 29 ± 16), 33 patients (11.5%) with permanent spacers (PI 6.1%, CMS 31 ± 14), 98 patients (34.2%) with two-stage revisions (PI 14.3%, CMS 42 ± 12) and 77 patients (26.8%) with one-stage revisions (PI 3.9%, CMS 49 ± 11). Debridement showed the highest PI rate (29.6%) and one-stage revisions reported the lowest PI rate (3.9%). Resection arthroplasty and spacers showed the poorest CMS when compared to the other procedures (p ≤ 0.0001). The debridement PI rate was significantly higher than almost any other procedure. CMS was significantly higher in patients undergoing revision compared to non-revision procedures (45 ± 12 vs. 35 ± 14) (p < 0.0001). One-stage revisions achieved significantly better results in terms of the PI rate compared to two-stage revisions (p = 0.0223), but not in terms of CMS.

Conclusion: Debridement showed the highest PI rate (29.6%) and should not be recommended for the management of infected shoulder arthroplasty. Revisions reported better functional outcomes compared to non-revision procedures. The presence of a significantly lower PI rate with comparablely high mean CMS values suggests that one-stage (where technically applicable) could be superior to two-stage revisions. Unfortunately, well-designed randomized controlled trials using validated patient-based outcomes are lacking in this field.

Level Of Evidence: Systematic Review of level IV studies, Level IV.

Citing Articles

Mid- to Long-Term Outcomes of Two-Stage Revision Arthroplasty for Periprosthetic Joint Infection of the Shoulder.

Hayta A, Akgun D, Do A, Dey Hazra R, Back D, Demirkiran N J Clin Med. 2025; 14(2).

PMID: 39860551 PMC: 11765727. DOI: 10.3390/jcm14020547.

One- vs. Two-Stage Revision for Periprosthetic Shoulder Infections: A Systematic Review and Meta-Analysis.

Bdeir M, Lerchl A, Hetjens S, Schilder A, Gravius S, Baumgartner T Antibiotics (Basel). 2024; 13(5).

PMID: 38786168 PMC: 11117334. DOI: 10.3390/antibiotics13050440.

Comparison of surgical treatment options in periprosthetic shoulder infections: a systematic review from 2016 to 2022.

Aksoy T, Yilmaz A, Beydemir A, Yataganbaba A, Huri G Ann Jt. 2024; 8:20.

PMID: 38529230 PMC: 10929292. DOI: 10.21037/aoj-22-48.

Systematic review and meta-analysis of single-stage vs two-stage revision for periprosthetic joint infection: a call for a prospective randomized trial.

Zhao Y, Fan S, Wang Z, Yan X, Luo H BMC Musculoskelet Disord. 2024; 25(1):153.

PMID: 38373976 PMC: 10875807. DOI: 10.1186/s12891-024-07229-z.

Periprosthetic Joint Infection Following Reverse Shoulder Arthroplasty Treated With Continuous Local Antibiotic Perfusion: A Case Report.

Mashiko R, Hatta T, Nagashima C Cureus. 2023; 15(11):e49193.

PMID: 38130511 PMC: 10735250. DOI: 10.7759/cureus.49193.

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