title: The treatment of deep shoulder infection and glenohumeral instability with debridement, reverse shoulder arthroplasty and postoperative antibiotics.
abstract: We retrospectively reviewed 21 patients (22 shoulders) who presented with deep infection after surgery to the shoulder, 17 having previously undergone hemiarthroplasty and five open repair of the rotator cuff. Nine shoulders had undergone previous surgical attempts to eradicate their infection. The diagnosis of infection was based on a combination of clinical suspicion (16 shoulders), positive frozen sections (> 5 polymorphonuclear leukocytes per high-power field) at the time of revision (15 shoulders), positive intra-operative cultures (18 shoulders) or the pre-operative radiological appearances. The patients were treated by an extensive debridement, intravenous antibiotics, and conversion to a reverse shoulder prosthesis in either a single- (10 shoulders) or a two-stage (12 shoulders) procedure. At a mean follow-up of 43 months (25 to 66) there was no evidence of recurrent infection. All outcome measures showed statistically significant improvements. Mean abduction improved from 36.1 degrees (sd 27.8) pre-operatively to 75.7 degrees (sd 36.0) (p < 0.0001), the mean forward flexion from 43.1 degrees (sd 33.5) to 79.5 degrees (sd 43.2) (p = 0.0003), and mean external rotation from 10.2 degrees (sd 18.7) to 25.4 degrees (sd 23.5) (p = 0.0037). There was no statistically significant difference in any outcome between the single-stage and the two-stage group.
authors.affiliation: Florida Orthopaedic Institute, 13020 N Telecom Parkway, Tampa, Florida 33637, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Cuff
authors.forename: N A
authors.initials: NA
authors.lastname: Virani
authors.forename: J
authors.initials: J
authors.lastname: Levy
authors.forename: M A
authors.initials: MA
authors.lastname: Frankle
authors.forename: A
authors.initials: A
authors.lastname: Derasari
authors.forename: B
authors.initials: B
authors.lastname: Hines
authors.forename: D R
authors.initials: DR
authors.lastname: Pupello
authors.forename: M
authors.initials: M
authors.lastname: Cancio
authors.forename: M
authors.initials: M
authors.lastname: Mighell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019643:Arthroplasty, Replacement; D003131:Combined Modality Therapy; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D018709:Statistics, Nonparametric; D013530:Surgical Wound Infection / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents