Paziuk Taylor, Cox Ryan M, Gutman Michael J, Rondon Alexander J, Nicholson Thema, Belden Katherine, Namdari Surena
Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA.
Department of Infectious Disease, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Shoulder Elbow. 2022 Dec;14(6):598-605. doi: 10.1177/17585732211019010. Epub 2021 Aug 29.
Diagnosis and treatment of shoulder periprosthetic joint infection is a difficult problem. The purpose of this study was to utilize the 2018 International Consensus Meeting definition of shoulder periprosthetic joint infection to categorize revision shoulder arthroplasty cases and determine variations in clinical presentation by presumed infection classification.
Retrospective review of patients undergoing revision shoulder arthroplasty at a single institution. Likelihood of periprosthetic joint infection was determined based on International Consensus Meeting scoring. All patients classified as definitive or probable periprosthetic joint infection were classified as periprosthetic joint infection. All patients classified as possible or unlikely periprosthetic joint infection were classified as aseptic. The periprosthetic joint infection cohort was subsequently divided into culture-negative, non-virulent microorganism, and virulent microorganism cohorts based on culture results.
Four hundred and sixty cases of revision shoulder arthroplasty were reviewed. Eighty (17.4%) patients were diagnosed as definite or probable periprosthetic joint infection, of which 29 (36.3%), 39 (48.8%), and 12 (15.0%) were classified as virulent, non-virulent, or culture-negative periprosthetic joint infection, respectively. There were significant differences among periprosthetic joint infection subgroups with regard to preoperative C-reactive protein (p = 0.020), erythrocyte sedimentation rate (p = 0.051), sinus tract presence (p = 0.008), and intraoperative purulence (p < 0.001). The total International Consensus Meeting criteria scores were also significantly different between the periprosthetic joint infection cohorts (p < 0.001).
While the diagnosis of shoulder periprosthetic joint infection has improved with the advent of International Consensus Meeting criteria, there remain distinct differences between periprosthetic joint infection classifications that warrant further investigation to determine the accurate diagnosis and optimal treatment.
肩关节假体周围感染的诊断和治疗是一个难题。本研究的目的是利用2018年国际共识会议对肩关节假体周围感染的定义，对翻修肩关节置换病例进行分类，并根据假定的感染分类确定临床表现的差异。
对在单一机构接受翻修肩关节置换术的患者进行回顾性研究。根据国际共识会议评分确定假体周围感染的可能性。所有被分类为确诊或可能的假体周围感染的患者被归类为假体周围感染。所有被分类为可能或不太可能的假体周围感染的患者被归类为无菌性。随后根据培养结果将假体周围感染队列分为培养阴性、非致病性微生物和致病性微生物队列。
回顾了460例翻修肩关节置换术病例。80例（17.4%）患者被诊断为确诊或可能的假体周围感染，其中29例（36.3%）、39例（48.8%）和12例（15.0%）分别被分类为致病性、非致病性或培养阴性的假体周围感染。假体周围感染亚组在术前C反应蛋白（p = 0.020）、红细胞沉降率（p = 0.051）、窦道存在情况（p = 0.008）和术中脓性分泌物（p < 0.001）方面存在显著差异。假体周围感染队列之间的国际共识会议总标准评分也存在显著差异（p < 0.001）。
虽然随着国际共识会议标准的出现，肩关节假体周围感染的诊断有所改善，但假体周围感染分类之间仍存在明显差异，需要进一步研究以确定准确的诊断和最佳治疗方法。
