Lemmens Laura, Geelen Hans, Depypere Melissa, De Munter Paul, Verhaegen Filip, Zimmerli Werner, Nijs Stefaan, Debeer Philippe, Metsemakers Willem-Jan
Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium.
Department of Clinical Biology, University Hospitals Leuven, Leuven, Belgium.
J Shoulder Elbow Surg. 2021 Nov;30(11):2514-2522. doi: 10.1016/j.jse.2021.04.014. Epub 2021 Apr 22.
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.
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.
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).
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.
人工肩关节周围感染（PSI）仍然是反式肩关节置换术（RSA）后一种极具破坏性的并发症。目前，与PSI管理相关的科学数据有限，最佳策略及相关临床结果仍不明确。美国传染病学会关于人工关节周围感染管理的指南主要基于髋关节和膝关节置换术后患者的数据。本研究的目的是评估这些指南对RSA术后PSI患者是否也有效。此外，还根据手术干预评估了功能结果。
对一个RSA数据库进行回顾性分析，以确定2004年至2018年期间初次和翻修RSA术后的感染情况。收集的数据包括年龄、性别、RSA的适应证、致病病原体、手术和抗菌治疗、功能结果及复发情况。
共确定36例PSI患者。手术治疗分为清创并保留植入物（DAIR）（n = 6，17%）；一期翻修（n = 1，3%）；二期翻修（n = 16，44%）；多期翻修（>2期）（n = 7，19%）；确定性间隔物植入（n = 2，6%）；以及切除关节成形术（n = 4，11%）。最常见的致病病原体是表皮葡萄球菌（n = 11，31%）和痤疮丙酸杆菌（n = 9，25%）。4例患者（11%）被诊断为复发，所有这些患者最初均采用DAIR方法治疗。中位随访期为36个月（范围24 - 132个月）。
PSI通常由低毒力病原体引起，这些病原体往往诊断延迟，导致手术时出现慢性感染。我们的结果表明，采用DAIR治疗慢性PSI患者复发率很高。此外，与保留植入物相比，植入物置换（即一期和二期置换）不会影响功能结果。因此，慢性PSI患者应采用植入物置换治疗。未来的研究应进一步阐明哪种手术策略（即一期置换与二期置换）总体效果更好。
