Nezwek Teron A, Dutcher Lincoln, Mascarenhas Luke, Woltemath Alyssa, Thirumavalavan Jeyvikram, Lund Julia, Lo Eddie Y, Krishnan Sumant G
The Shoulder Center Research, Baylor Scott and White Research Institute, Dallas, TX, USA.
The Shoulder Service, Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA.
JSES Int. 2021 Aug 6;5(6):1062-1066. doi: 10.1016/j.jseint.2021.06.003. eCollection 2021 Nov.
Reverse total shoulder arthroplasty (RTSA) has become an increasingly popular surgery for patients with rotator cuff arthropathy, unreconstructible proximal humeral fracture, and end-stage glenohumeral arthritis. The increased annual volume of RTSAs has resulted in more postoperative complications and revision rates between 3.3% and 10.1%. Postoperative infection is one of the most common complications requiring revision surgery after primary RTSA. This study assesses patient-specific risk factors for development of early infection after primary RTSA in a single high-volume shoulder arthroplasty institution.
From 2014 to 2019, 902 consecutive primary RTSAs were performed for surgical treatment of rotator cuff arthropathy, glenohumeral arthritis, inflammatory arthropathy, and/or dislocation. Excluding proximal humeral or scapula fractures, 756 cases met the inclusion criteria and had a minimum of 3-month follow-up. All surgeries were performed using the same surgical technique and received similar antibiotic prophylaxis. Age, patient demographics, medical history, smoking history, and prior ipsilateral shoulder treatment and/or surgery were recorded. Multivariable logistic regression analysis was used to determine risk factors associated with development of postoperative shoulder infection.
Thirty-five patients did not meet minimum follow-up criteria and were lost to follow-up. Overall, of 721, 22 patients (3%) developed a postoperative ipsilateral shoulder infection. Previous nonarthroplasty surgery and history of rheumatoid arthritis were significantly associated with the development of postoperative shoulder infection. Amongst 196 patients who had previous nonarthroplasty shoulder surgery, there were 12 postoperative shoulder infections (6%) compared with those without previous shoulder surgery (10 of 525, 2%) ( = .003). Among 58 patients with rheumatoid arthritis, there were 5 postoperative shoulder infections (9%) compared with patients without rheumatoid arthritis (17 of 663, 3%) ( = .010). Patient age, gender, smoking status, history of diabetes mellitus, history of cancer/immunosuppression, and prior cortisone injection did not demonstrate significant associations with the development of postoperative infection.
Prior nonarthroplasty shoulder surgery and/or rheumatoid arthritis are independently associated with the development of postoperative infection after primary RTSA. Patients who demonstrate these risk factors should be appropriately evaluated and preoperatively counseled before undergoing primary RTSA. Strong consideration should be given to avoid minimally invasive nonarthroplasty surgery as a temporizing measure to delay definitive RTSA.
反式全肩关节置换术（RTSA）已成为治疗肩袖关节病、不可重建的肱骨近端骨折以及终末期盂肱关节炎患者越来越常用的手术。RTSA手术量逐年增加，导致术后并发症增多，翻修率在3.3%至10.1%之间。术后感染是初次RTSA后需要翻修手术的最常见并发症之一。本研究评估了在一家高手术量的肩关节置换机构中，初次RTSA后发生早期感染的患者特异性危险因素。
2014年至2019年，连续对902例患者实施初次RTSA，用于治疗肩袖关节病、盂肱关节炎、炎性关节病和/或脱位。排除肱骨近端或肩胛骨骨折患者后，756例符合纳入标准，且至少随访3个月。所有手术均采用相同的手术技术，并接受相似的抗生素预防措施。记录患者的年龄、人口统计学特征、病史、吸烟史以及同侧肩部既往治疗和/或手术情况。采用多变量逻辑回归分析确定与术后肩部感染发生相关的危险因素。
35例患者未达到最低随访标准，失访。总体而言，在721例患者中，22例（3%）发生了术后同侧肩部感染。既往非关节置换手术和类风湿关节炎病史与术后肩部感染的发生显著相关。在196例既往有非关节置换肩部手术的患者中，有12例术后发生肩部感染（6%），而无既往肩部手术的患者中（525例中有10例，2%）（P = 0.003）。在58例类风湿关节炎患者中，有5例术后发生肩部感染（9%），而无类风湿关节炎的患者中（663例中有17例，3%）（P = 0.010）。患者的年龄、性别、吸烟状况、糖尿病史、癌症/免疫抑制病史以及既往皮质类固醇注射史与术后感染的发生无显著相关性。
既往非关节置换肩部手术和/或类风湿关节炎与初次RTSA后术后感染的发生独立相关。具有这些危险因素的患者在接受初次RTSA之前应进行适当评估并给予术前咨询。应强烈考虑避免将微创非关节置换手术作为延迟确定性RTSA的临时措施。
