title: Treatment strategies for infection after reverse shoulder arthroplasty.
abstract: BACKGROUND
  Infection after reverse shoulder arthroplasty (RSA) is a disastrous complication. No clear guidelines describing specific management strategies for infection after RSA are available.
  
  
  METHODS
  We retrospectively analyzed 20 patients treated for deep infection after RSA. Initial irrigation and debridement and exchange of the polyethylene inlay were performed in seven patients, and initial two-stage revision was performed in 12 and initial resection arthroplasty in one patient. Patient charts were reviewed for risk factors, clinical symptoms and investigations of those symptoms, pre- and postoperative X-rays, interval until revision surgery, causative bacteria, complications, final clinical outcome and patient satisfaction.
  
  
  RESULTS
  The mean overall postoperative Constant-Murley Score (CMS) was 42.6 points, the mean UCLA score was 20.8, the mean simple shoulder test (SST) was 5.5, and the mean VAS was 1.5. When comparing the CMS, UCLA score and the SST between the revision RSA group and the resection group, significant differences between the groups were found (p<0.05). Irrigation, debridement and exchange of the polyethylene inlay were successful only in two of the four patients with acute infection. The three patients with subacute infections were treated with initial irrigation and debridement and exchange of the polyethylene inlay, which were not successful.
  
  
  CONCLUSIONS
  The relatively high patient satisfaction can be explained by the low pain level once the patient is free from infection. However, functional results are poor in most cases, and this possible outcome must be discussed with the patient in the preoperative setting.
authors.affiliation: Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria, r.ortmaier@gmail.com.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Ortmaier
authors.forename: Herbert
authors.initials: H
authors.lastname: Resch
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hitzl
authors.forename: Michael
authors.initials: M
authors.lastname: Mayer
authors.forename: Ottokar
authors.initials: O
authors.lastname: Stundner
authors.forename: Mark
authors.initials: M
authors.lastname: Tauber
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000379:methods; D003646:Debridement / Q000379:methods; D004322:Drainage / Q000379:methods; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000209:etiology; D007595:Joint Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D012785:Shoulder Joint; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome