Rodrigues-Lopes Rita, Silva Fábia, Torres João
Faculty of Medicine of the University of Porto, Porto, Portugal.
Department of Orthopaedics and Traumatology, University Hospital Center of São João, Porto, Portugal.
J Shoulder Elbow Surg. 2024 Mar;33(3):722-737. doi: 10.1016/j.jse.2023.09.007. Epub 2023 Oct 14.
There is still no consensus among surgeons on whether to perform a 1- or 2-stage surgical revision in infected shoulder arthroplasties. The aim of this systematic review and meta-analysis is to rigorously synthesize published studies evaluating the clinical outcomes, recurrence of infection, and other clinical complications in order to discuss which is the best strategy for treating periprosthetic joint infection after shoulder arthroplasty.
Upon research using the PubMed, Scopus, and Web of Science databases, in November 2022, studies that presented 1- or 2-stage surgical revision as a treatment for periprosthetic joint infection after shoulder arthroplasty and assessed the reinfection rate on these patients, as well as other clinical outcomes, with a minimum follow-up of 12 months, were included. Study quality was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) score. Reinfection and complication rates were extracted, and pooled estimates were calculated using the random-effect model.
After careful screening, 44 studies were included, 5 reporting on 1-stage and 30 on 2-stage revisions and 9 assessing both strategies. A total of 185 shoulders were reported in 1-stage revision studies, whereas 526 shoulders were reported in 2-stage revision studies. The overall pooled random-effects reinfection rate was 6.68% (95% confidence interval [CI]: 3.76-10.13), with low heterogeneity (I = 28%, P = .03). One-stage revision showed a reinfection rate of 1.14% (95% CI: 0.00-4.88), whereas 2-stage revision analysis revealed a reinfection rate of 8.81% (95% CI: 4.96-13.33). There were significant statistical differences between 1- and 2-stage reinfection rates (P = .04). The overall pooled rate for other clinical complications was 16.76% (95% CI: 9.49-25.15), with high heterogeneity (I = 70%, P < .01). One-stage revision had a complication rate of 6.11% (95% CI: 1.58-12.39), whereas the 2-stage revision complication rate was 21.26% (95% CI: 11.51-32.54). This difference was statistically significant (P = .03).
This is the first systematic review and meta-analysis showing significant statistical differences between 1- and 2-stage surgical revision in infected shoulder arthroplasties. Provided the right conditions exist, 1-stage revision shows better results in infection control, with lower clinical complications and possible better clinical outcomes.
对于感染性肩关节置换术应采用一期还是二期手术翻修，外科医生之间仍未达成共识。本系统评价和荟萃分析的目的是严格综合已发表的研究，评估临床结局、感染复发情况及其他临床并发症，以探讨肩关节置换术后假体周围关节感染的最佳治疗策略。
于2022年11月通过检索PubMed、Scopus和Web of Science数据库，纳入将一期或二期手术翻修作为肩关节置换术后假体周围关节感染治疗方法，并评估这些患者再感染率及其他临床结局、且随访时间至少12个月的研究。采用非随机研究方法学指数（MINORS）评分评估研究质量。提取再感染率和并发症发生率，并使用随机效应模型计算合并估计值。
经过仔细筛选，纳入44项研究，其中5项报告一期翻修，30项报告二期翻修，9项评估了两种策略。一期翻修研究共报告185例肩关节，二期翻修研究共报告526例肩关节。总体合并随机效应再感染率为6.68%（95%置信区间[CI]：3.76 - 10.13），异质性较低（I² = 28%，P = 0.03）。一期翻修的再感染率为1.14%（95% CI：0.00 - 4.88），而二期翻修分析显示再感染率为8.81%（95% CI：4.96 - 13.33）。一期和二期再感染率之间存在显著统计学差异（P = 0.04）。其他临床并发症的总体合并发生率为16.76%（95% CI：9.49 - 25.15），异质性较高（I² = 70%，P < 0.01）。一期翻修的并发症发生率为6.11%（95% CI：1.58 - 12.39），而二期翻修的并发症发生率为21.26%（95% CI：11.51 - 32.54）。这种差异具有统计学意义（P = 0.03）。
这是第一项系统评价和荟萃分析，显示感染性肩关节置换术一期和二期手术翻修之间存在显著统计学差异。在具备合适条件的情况下，一期翻修在感染控制方面效果更好，临床并发症更低，可能具有更好的临床结局。
