Rondon Alexander J, Paziuk Taylor, Gutman Michael J, Williams Gerald R, Namdari Surena
Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
J Shoulder Elbow Surg. 2021 Dec;30(12):e732-e740. doi: 10.1016/j.jse.2021.05.005. Epub 2021 Jun 2.
Periprosthetic joint infection following shoulder arthroplasty represents a challenging problem for orthopedic surgeons. Although recent studies have supported 2-stage exchanges, this treatment choice may not be appropriate for all patients. Definitive antibiotic spacer placement represents one treatment strategy with limited reported outcomes in the literature. The purpose of this study was to investigate the mortality rate and functional outcomes associated with definitive spacer placement.
A retrospective chart review identified 17 patients who were treated with definitive antibiotic spacer placement (18 spacers) and were followed up for a minimum of 2 years after surgery. The mortality rate over the study period was determined. Demographic information, clinical course, patient-reported outcomes (American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation score, and Veterans RAND 12 [VR-12] score), infection parameters as defined by International Consensus Meeting criteria, radiographic evaluation findings, and rotator cuff integrity at the time of spacer placement were collected.
Seventeen patients underwent treatment with retained antibiotic spacers at a mean age of 62.4 years (range, 50-73 years). Ten patients were women, and the mean body mass index was 30.5 (range, 22.9-39.9). Spacer placement occurred at a mean of 6.1 years (range, 0.48-14.9 years) following index arthroplasty. Five patients required spacer exchange. The most common organisms were Cutibacterium acnes (6) and methicillin-sensitive Staphylococcus aureus (6); in addition, methicillin-resistant S aureus (2), coagulase-negative Staphylococcus (2), Serratia marcescens (1), gram-positive cocci (1), Enterobacter faecalis (1), Enterobacter cloacae (1), diphtheroids (1), and an infection with negative culture findings (1) were observed. The mortality rate was 52.9% (9 of 17 patients). Among the 8 surviving patients, the mean American Shoulder and Elbow Surgeons score was 33.9 (range, 13.3-80.0), the mean Single Assessment Numeric Evaluation score was 35.6 (range, 0.0-80.0), the mean VR-12 mental score was 57.2 (range, 36.6-66.9), and the mean VR-12 physical score was 37.1 (range, 21.7-64.0) at a mean of 4.7 years (range, 2.0-8.8 years).
Definitive antibiotic spacer placement is an acceptable method to treat infection in medically frail patients who have a high mortality risk. Spacer exchange may be necessary because of persistent infection, and functional results are poor.
肩关节置换术后假体周围关节感染是骨科医生面临的一个具有挑战性的问题。尽管最近的研究支持两阶段翻修，但这种治疗选择可能并不适用于所有患者。确定性抗生素间隔物植入是一种治疗策略，文献中报道的结果有限。本研究的目的是调查与确定性间隔物植入相关的死亡率和功能结果。
一项回顾性图表审查确定了17例接受确定性抗生素间隔物植入治疗的患者（18个间隔物），并在术后至少随访2年。确定研究期间的死亡率。收集人口统计学信息、临床过程、患者报告的结果（美国肩肘外科医生评分、单评估数字评价评分和退伍军人兰德12项[VR-12]评分）、国际共识会议标准定义的感染参数、影像学评估结果以及间隔物植入时的肩袖完整性。
17例患者接受了保留抗生素间隔物治疗，平均年龄62.4岁（范围50-73岁）。10例为女性，平均体重指数为30.5（范围22.9-39.9）。间隔物植入发生在初次关节置换术后平均6.1年（范围0.48-14.9年）。5例患者需要更换间隔物。最常见的病原体是痤疮丙酸杆菌（6例）和对甲氧西林敏感的金黄色葡萄球菌（6例）；此外，还观察到耐甲氧西林金黄色葡萄球菌（2例）、凝固酶阴性葡萄球菌（2例）、粘质沙雷氏菌（1例）、革兰氏阳性球菌（1例）、粪肠球菌（1例）、阴沟肠杆菌（1例）、类白喉杆菌（1例）以及1例培养结果为阴性的感染。死亡率为52.9%（17例患者中的9例）。在8例存活患者中，平均美国肩肘外科医生评分为33.9（范围13.3-80.0），平均单评估数字评价评分为35.6（范围0.0-80.0），平均VR-12精神评分为57.2（范围36.6-66.9），平均VR-12身体评分为37.1（范围21.7-64.0），平均随访时间为4.7年（范围2.0-8.8年）。
对于具有高死亡风险的体弱患者，确定性抗生素间隔物植入是治疗感染的一种可接受的方法。由于持续感染，可能需要更换间隔物，且功能结果较差。
