Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy.
Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy.
J Shoulder Elbow Surg. 2019 Jun;28(6):1193-1203. doi: 10.1016/j.jse.2019.02.014. Epub 2019 Apr 16.
Periprosthetic shoulder infection (PSI) is one of the most challenging complications after shoulder arthroplasty. Different treatments have been proposed, but the best surgical procedure remains disputed in the current literature. This systematic review investigated the outcomes of revision surgery after PSI.
The PubMed and Scopus databases were used to search keywords in April 2018. Of 2157 titles, 34 studies were finally analyzed. Demographics, laboratory and microbiological data, types of implants, surgical techniques with complications and reoperations, eradication rates, and clinical and functional outcomes were reported.
A total of 754 patients were identified. Cutibacterium acnes (C. acnes) was the most common microorganism found both in PSI (33%) and persistent infections (40%). Preoperatively, C-reactive protein was elevated in 70% of patients with PSI. Reverse shoulder arthroplasty had a lower prevalence of infection (P < .001). The eradication rate was 96% with 1 stage, 93% with permanent spacers, 86% with 2 stages, 85% with resection arthroplasty, and 65% with irrigation and débridement. One-stage revision was the best treatment, considering postoperative flexion and abduction, compared with resection arthroplasty, permanent spacers, and 2-stage revision. One-stage revision showed fewer postoperative complications than irrigation and débridement, resection arthroplasty, and 2-stage surgery. Two-stage surgery was the most common treatment, and the functional score demonstrated no differences between 2-stage and 1-stage procedures.
Our review suggests that a 1-stage procedure should be recommended to treat PSI. Two-stage revision could be reserved for select cases in which the bacterium involved is unknown.
假体周围肩部感染（PSI）是肩关节置换术后最具挑战性的并发症之一。已经提出了不同的治疗方法，但在当前文献中，最佳手术方法仍存在争议。本系统评价调查了 PSI 后翻修手术的结果。
2018 年 4 月，我们使用 PubMed 和 Scopus 数据库搜索关键词。在 2157 篇标题中，最终分析了 34 项研究。报告了人口统计学、实验室和微生物学数据、植入物类型、伴有并发症和再次手术的手术技术、清除率以及临床和功能结果。
共确定了 754 名患者。在 PSI（33%）和持续性感染（40%）中，最常见的微生物是痤疮丙酸杆菌（C. acnes）。术前，PSI 患者中有 70%的 C 反应蛋白升高。反向肩关节置换术的感染发生率较低（P<0.001）。1 期手术的清除率为 96%，永久性间隔器为 93%，2 期手术为 86%，切除关节成形术为 85%，灌洗清创术为 65%。与切除关节成形术、永久性间隔器和 2 期翻修相比，1 期翻修在术后屈曲和外展方面是最佳治疗方法。与灌洗清创术、切除关节成形术和 2 期手术相比，1 期翻修术后并发症较少。2 期手术是最常见的治疗方法，2 期和 1 期手术的功能评分没有差异。
我们的综述表明，应推荐 1 期手术治疗 PSI。对于涉及细菌未知的病例，可以保留 2 期翻修。
