Clin Orthop Surg.  2018 Sep;10(3):344-351. 10.4055/cios.2018.10.3.344.

Outcomes of Shoulder Arthroplasty Performed for Postinfectious Arthritis

Affiliations
  • 1The Rothman Institute of Orthopaedics, Thomas Jefferson University Hospitals, Philadelphia, PA, USA. padegimase@gmail.com

Abstract

BACKGROUND
The purpose of this study was to evaluate the functional outcomes, infection rate, and complications associated with shoulder arthroplasty for sequelae of prior septic arthritis.
METHODS
This is a retrospective cohort study of 17 patients who underwent shoulder arthroplasty for sequelae of septic arthritis. Patients were analyzed for patient-reported outcomes, complications, and reoperations.
RESULTS
The 17 patients in this cohort were an average age of 65.4 ± 12.2 years old, were 58.8% male, and had an average body mass index of 27.9 ± 4.1 kg/m2. These patients underwent 14 reverse shoulder arthroplasties (RSAs; 11 after antibiotic spacer placement), one anatomic total shoulder arthroplasty after antibiotic spacer placement, and two hemiarthroplasties (both after antibiotic spacer placement). Two patients underwent reoperation (dislocated RSAs). There were four complications (23.5%): two RSA dislocations, one acromial stress fracture, and one atraumatic rotator cuff tear after hemiarthroplasty. There were no cases of postoperative wound complications or infection. At an average of 4.1 ± 1.8 years of follow-up for all 17 of 17 cases, the average visual analogue scale pain score was 4.6 ± 2.3, average Single Assessment Numeric Evaluation Score was 59.3 ± 23.7, average American Shoulder and Elbow Surgeons Score was 57.6 ± 15.5, and average Simple Shoulder Test was 6.9 ± 2.6 based on "yes" responses.
CONCLUSIONS
Shoulder arthroplasty after septic arthritis had inconsistent functional outcomes and high complication rates but no reinfection.

Keyword

Shoulder replacement arthroplasty; Infectious arthritis; Complications

MeSH Terms

Arthritis, Infectious
Arthritis, Reactive*
Arthroplasty*
Body Mass Index
Cohort Studies
Dislocations
Elbow
Follow-Up Studies
Fractures, Stress
Hemiarthroplasty
Humans
Male
Reoperation
Retrospective Studies
Rotator Cuff
Shoulder*
Surgeons
Tears
Wounds and Injuries

Figure

  • Fig. 1 Preoperative true anteroposterior (AP) (A), AP (B), and axillary (C) radiographs of an 81-year-old female who had multifocal septic native arthritis with one previous shoulder irrigation and debridement.

  • Fig. 2 Three-year postoperative true anteroposterior (AP) (A), AP (B), and scapular Y (C) views of an 81-year-old female who had multifocal septic native arthritis with one previous shoulder irrigation and debridement and underwent a two-staged reverse shoulder arthroplasty.


Reference

1. Cleeman E, Auerbach JD, Klingenstein GG, Flatow EL. Septic arthritis of the glenohumeral joint: a review of 23 cases. J Surg Orthop Adv. 2005; 14(2):102–107. PMID: 16115438.
2. Jeon IH, Choi CH, Seo JS, Seo KJ, Ko SH, Park JY. Arthroscopic management of septic arthritis of the shoulder joint. J Bone Joint Surg Am. 2006; 88(8):1802–1806. PMID: 16882905.
Article
3. Klinger HM, Baums MH, Freche S, Nusselt T, Spahn G, Steckel H. Septic arthritis of the shoulder joint: an analysis of management and outcome. Acta Orthop Belg. 2010; 76(5):598–603. PMID: 21138213.
4. Mileti J, Sperling JW, Cofield RH. Shoulder arthroplasty for the treatment of postinfectious glenohumeral arthritis. J Bone Joint Surg Am. 2003; 85(4):609–614. PMID: 12672834.
Article
5. Dudkiewicz I, Salai M, Chechik A, Ganel A. Total hip arthroplasty after childhood septic hip in patients younger than 25 years of age. J Pediatr Orthop. 2000; 20(5):585–587. PMID: 11008736.
Article
6. Jerry GJ Jr, Rand JA, Ilstrup D. Old sepsis prior to total knee arthroplasty. Clin Orthop Relat Res. 1988; (236):135–140.
Article
7. Jupiter JB, Karchmer AW, Lowell JD, Harris WH. Total hip arthroplasty in the treatment of adult hips with current or quiescent sepsis. J Bone Joint Surg Am. 1981; 63(2):194–200. PMID: 7462276.
Article
8. Kim YH. Total arthroplasty of the hip after childhood sepsis. J Bone Joint Surg Br. 1991; 73(5):783–786. PMID: 1894666.
Article
9. Nazarian DG, de Jesus D, McGuigan F, Booth RE Jr. A two-stage approach to primary knee arthroplasty in the infected arthritic knee. J Arthroplasty. 2003; 18(7 Suppl 1):16–21.
Article
10. Chen CE, Wang JW, Juhn RJ. Total hip arthroplasty for primary septic arthritis of the hip in adults. Int Orthop. 2008; 32(5):573–580. PMID: 17483946.
Article
11. Lee GC, Pagnano MW, Hanssen AD. Total knee arthroplasty after prior bone or joint sepsis about the knee. Clin Orthop Relat Res. 2002; (404):226–231. PMID: 12439264.
Article
12. Brook I, Frazier EH. Infections caused by Propionibacterium species. Rev Infect Dis. 1991; 13(5):819–822. PMID: 1962090.
Article
13. Dodson CC, Craig EV, Cordasco FA, et al. Propionibacterium acnes infection after shoulder arthroplasty: a diagnostic challenge. J Shoulder Elbow Surg. 2010; 19(2):303–307. PMID: 19884021.
Article
14. Foruria AM, Fox TJ, Sperling JW, Cofield RH. Clinical meaning of unexpected positive cultures (UPC) in revision shoulder arthroplasty. J Shoulder Elbow Surg. 2013; 22(5):620–627. PMID: 22981448.
Article
15. Mook WR, Klement MR, Green CL, Hazen KC, Garrigues GE. The Incidence of propionibacterium acnes in open shoulder surgery: a controlled diagnostic study. J Bone Joint Surg Am. 2015; 97(12):957–963. PMID: 26085528.
16. Padegimas EM, Lawrence C, Narzikul AC, et al. Future surgery after revision shoulder arthroplasty: the impact of unexpected positive cultures. J Shoulder Elbow Surg. 2017; 26(6):975–981. PMID: 28087166.
Article
17. Sethi PM, Sabetta JR, Stuek SJ, et al. Presence of Propionibacterium acnes in primary shoulder arthroscopy: results of aspiration and tissue cultures. J Shoulder Elbow Surg. 2015; 24(5):796–803. PMID: 25483906.
Article
18. Updegrove GF, Armstrong AD, Kim HM. Preoperative and intraoperative infection workup in apparently aseptic revision shoulder arthroplasty. J Shoulder Elbow Surg. 2015; 24(3):491–500. PMID: 25487903.
Article
19. Morris BJ, Waggenspack WN Jr, Laughlin MS, Elkousy HA, Gartsman GM, Edwards TB. Reverse shoulder arthroplasty for management of postinfectious arthropathy with rotator cuff deficiency. Orthopedics. 2015; 38(8):e701–e707. PMID: 26270757.
Article
20. Schoch B, Allen B, Mileti J, Sperling JW, Cofield RH. Shoulder arthroplasty for the treatment of postinfectious glenohumeral arthritis. J Shoulder Elbow Surg. 2014; 23(9):1327–1333. PMID: 24618194.
Article
21. Day JS, Lau E, Ong KL, Williams GR, Ramsey ML, Kurtz SM. Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015. J Shoulder Elbow Surg. 2010; 19(8):1115–1120. PMID: 20554454.
Article
22. Kim SH, Wise BL, Zhang Y, Szabo RM. Increasing incidence of shoulder arthroplasty in the United States. J Bone Joint Surg Am. 2011; 93(24):2249–2254. PMID: 22258770.
Article
23. Padegimas EM, Maltenfort M, Lazarus MD, Ramsey ML, Williams GR, Namdari S. Future patient demand for shoulder arthroplasty by younger patients: national projections. Clin Orthop Relat Res. 2015; 473(6):1860–1867. PMID: 25758376.
Article
24. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373–383. PMID: 3558716.
Article
25. Williams GN, Gangel TJ, Arciero RA, Uhorchak JM, Taylor DC. Comparison of the Single Assessment Numeric Evaluation method and two shoulder rating scales: outcomes measures after shoulder surgery. Am J Sports Med. 1999; 27(2):214–221. PMID: 10102104.
26. Michener LA, McClure PW, Sennett BJ. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg. 2002; 11(6):587–594. PMID: 12469084.
Article
27. Matsen FA 3rd, Ziegler DW, DeBartolo SE. Patient self-assessment of health status and function in glenohumeral degenerative joint disease. J Shoulder Elbow Surg. 1995; 4(5):345–351. PMID: 8548437.
Article
28. Padegimas EM, Narzikul A, Lawrence C, et al. Antibiotic spacers in shoulder arthroplasty: comparison of stemmed and stemless implants. Clin Orthop Surg. 2017; 9(4):489–496. PMID: 29201302.
Article
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