Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA.
Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA.
J Shoulder Elbow Surg. 2020 Sep;29(9):e325-e329. doi: 10.1016/j.jse.2020.01.065. Epub 2020 Mar 31.
The treatment of periprosthetic shoulder infections and proximal humerus osteomyelitis is challenging. The outcomes of antibiotic cement spacer retention are poorly defined in the literature. The purpose of this study was to review long-term functional and patient-reported outcomes data of patients with retained antibiotic cement spacers. We predict reasonable functional outcomes and minimal pain.
We identified 22 patients of the senior author who have been treated with definitive antibiotic spacer placement. All patients were originally offered a 2-stage revision and declined. Twelve patients had a minimum follow-up of 2 years and were included in our cohort. Mean age was 70.7 (range 59-81), 8/12 patients were female, and the average body mass index was 27.8 (range = 17-45). Functional outcome assessments included the Standardized Shoulder Assessment Form, the Quick Disabilities of the Arm, Shoulder, and Hand Score (QuickDASH), and visual analog scale (VAS) along with clinical range of motion examination.
The patients were followed up for a mean of 5.6 years. Eight patients had spacer placement for chronic shoulder arthroplasty infections, whereas 4 patients had spacer placement for chronic osteomyelitis of the proximal humerus. No patients were currently being treated with suppressive antibiotics. One patient had negative cultures at the time of antibiotic spacer placement. The most common organisms were Cutibacterium acnes (6), Staphylococcus epidermidis (6), and methicillin-resistant Staphylococcus aureus (4), with 4 patients growing more than 1 species. The average ASES score was 54 (range = 27-73), QuickDASH was 45 (range = 14-89), and VAS score 2.8 (range = 0-8). Average active range of motion was 68° of forward elevation and 35° of external rotation.
Retention of antibiotic cement spacer is a viable option in the treatment algorithm for chronic shoulder infections. Long-term antibiotic cement spacer may be considered for those patients who are unwilling or unable to undergo a 2-stage revision. Patients can expect a reasonable amount of function and little to no pain with an antibiotic cement spacer.
治疗人工关节周围感染和肱骨头近端骨髓炎具有挑战性。文献中对保留抗生素骨水泥间隔物的治疗效果的定义并不完善。本研究的目的是回顾保留抗生素骨水泥间隔物患者的长期功能和患者报告结果数据。我们预计会有合理的功能结果和最小的疼痛。
我们确定了高级作者治疗的 22 例保留抗生素骨水泥间隔物的患者。所有患者最初都被建议进行 2 期翻修，但均拒绝。12 例患者的随访时间至少为 2 年，包括在我们的队列中。平均年龄为 70.7 岁（范围为 59-81 岁），8/12 例为女性，平均体重指数为 27.8（范围为 17-45）。功能评估包括标准肩部评估表、上肢残疾快速评分（QuickDASH）、视觉模拟评分（VAS）以及临床活动范围检查。
患者的平均随访时间为 5.6 年。8 例患者因慢性肩关节置换感染而接受间隔物植入，4 例患者因肱骨头慢性骨髓炎而接受间隔物植入。目前没有患者接受抑制性抗生素治疗。1 例患者在抗生素骨水泥间隔物植入时培养物呈阴性。最常见的病原体是痤疮丙酸杆菌（6 例）、表皮葡萄球菌（6 例）和耐甲氧西林金黄色葡萄球菌（4 例），4 例患者培养出超过 1 种病原体。平均 ASES 评分为 54（范围为 27-73），QuickDASH 评分为 45（范围为 14-89），VAS 评分为 2.8（范围为 0-8）。平均主动活动范围为前向抬高 68°和外旋 35°。
保留抗生素骨水泥间隔物是治疗慢性肩部感染的一种可行方案。对于那些不愿意或无法进行 2 期翻修的患者，可以考虑长期使用抗生素骨水泥间隔物。保留抗生素骨水泥间隔物的患者可以预期有合理的功能和几乎没有疼痛。
