Bdeir Mohamad, Lerchl Aimée, Hetjens Svetlana, Schilder Andreas, Gravius Sascha, Baumgärtner Tobias, Darwich Ali
Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Institute of Medical Statistics and Biomathematics, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Antibiotics (Basel). 2024 May 14;13(5):440. doi: 10.3390/antibiotics13050440.
Periprosthetic shoulder infection (PSI) remains a challenging complication after shoulder arthroplasty. Therapeutic options include one- or two-stage revision, irrigation and debridement, and resection arthroplasty. With our systematic review and meta-analysis, we aimed to compare one- and two-stage revisions for periprosthetic shoulder joint infections and determine the most appropriate therapeutic procedure. We performed an extensive literature search in PubMed, Ovid Medline, Cochrane Library, Web of Science, and CINAHL and filtered out all relevant studies. The meta-analysis was performed using the random-effects model, heterogeneity was analyzed using I, and publication bias was assessed using the Egger's test. A total of 8 studies with one-stage revisions, 36 studies with two-stage revisions, and 12 studies with both one-stage and two-stage revisions were included. According to the random-effects model, the reinfection rate for the entirety of the studies was 12.3% (95% Cl: 9.6-15.3), with a low-to-moderate heterogeneity of I = 47.72%. The reinfection rate of the one-stage revisions was 10.9%, which was significantly lower than the reinfection rate of the two-stage revisions, which was 12.93% ( = 0.0062). The one-stage revision rate was significantly lower with 1.16 vs. 2.25 revisions in the two-stage revision group ( < 0.0001). The postoperative functional outcome in one-stage-revised patients was comparable but not statistically significant ( = 0.1523). In one- and two-stage revisions, most infections were caused by . In summary, our systematic review and meta-analysis show the superiority of single-stage revision regarding reinfection and revision rates in periprosthetic shoulder joint infection.
人工关节周围肩部感染（PSI）仍然是肩关节置换术后具有挑战性的并发症。治疗选择包括一期或二期翻修、冲洗和清创以及关节切除成形术。通过我们的系统评价和荟萃分析，我们旨在比较人工关节周围肩关节感染的一期和二期翻修，并确定最合适的治疗方法。我们在PubMed、Ovid Medline、Cochrane图书馆、Web of Science和CINAHL中进行了广泛的文献检索，并筛选出所有相关研究。使用随机效应模型进行荟萃分析，使用I²分析异质性，并使用Egger检验评估发表偏倚。共纳入8项一期翻修研究、36项二期翻修研究以及12项一期和二期翻修均有的研究。根据随机效应模型，所有研究的再感染率为12.3%（95%CI：9.6 - 15.3），I²为47.72%，异质性低到中等。一期翻修的再感染率为10.9%，显著低于二期翻修的再感染率12.93%（P = 0.0062）。一期翻修率显著更低，一期翻修组为1.16次，二期翻修组为2.25次（P < 0.0001）。一期翻修患者的术后功能结果具有可比性，但无统计学意义（P = 0.1523）。在一期和二期翻修中，大多数感染是由……引起的。总之，我们的系统评价和荟萃分析显示了在人工关节周围肩关节感染的再感染和翻修率方面，一期翻修的优越性。
