title: Management of deep infection after reverse total shoulder arthroplasty: a case series.
abstract: BACKGROUND
  Reverse total shoulder arthroplasty (RSA) is being increasingly used in the treatment of disabling shoulder conditions. This study reports the management of deep infections after RSA.
  
  
  METHODS
  Eight of 138 patients were treated for deep infection after the index procedure. A retrospective review was performed to identify risk factors, methods of management, and determine ultimate outcome. A minimum of 12-month follow-up was available in 7 of 8 patients.
  
  
  RESULTS
  Six infections occurred in patients who had had previous shoulder surgery. The causative bacterial organism was identified in 6 patients. Deep infection occurred in 3 patients with diabetes mellitus. Antibiotic cement was used in all cases. Six patients were managed with irrigation and debridement and retention of components. Two patients with of Staphylococcus aureus infection ultimately required resection arthroplasty. Patients managed with irrigation and debridement, intravenous antibiotics, and retention of components demonstrated good pain relief and function, without evidence of radiographic loosening. Resection resulted in pain relief but poor functional outcomes.
  
  
  CONCLUSIONS
  Limited literature is available regarding the management of deep infection in patients with RSA. Component removal after a RSA creates increased bone loss due to a cemented humeral component and glenoid baseplate with several large screws. Five of 7 patients with deep infection had undergone previous shoulder surgery. We recommend that patients should be managed with an initial irrigation and debridement, appropriate intravenous antibiotics, and component retention.
authors: Orthopaedic Specialists of Dallas, Rockwall, TX, USA.
authors: John A
authors: JA
authors: Zavala
authors: J C
authors: JC
authors: Clark
authors: Michael J
authors: MJ
authors: Kissenberth
authors: Stefan J
authors: SJ
authors: Tolan
authors: Richard J
authors: RJ
authors: Hawkins
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001178:Arthroplasty / Q000009:adverse effects*; D003646:Debridement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000601:surgery*; D013203:Staphylococcal Infections / Q000209:etiology / Q000382:microbiology / Q000628:therapy*; D013211:Staphylococcus aureus / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents