title: Surgical management of the infected reversed shoulder arthroplasty: a French multicenter study of reoperation in 32 patients.
abstract: BACKGROUND
  In a retrospective multicenter study, we evaluated the efficiency and outcomes of the different therapeutic options for infection after reversed shoulder arthroplasty.
  
  
  METHODS
  Thirty-two patients were reoperated on for infection after reversed shoulder arthroplasty between 1996 and 2011. The mean age was 71 (55-83) years. The involved implants were primary prostheses in 23 cases and revision prostheses in 9 cases. The average preoperative Constant score was 34 (11-69). Six of these patients needed 2 successive procedures. A total of 38 procedures were performed: débridement (13), 1-stage (5) or 2-stage revision (14), or implant removal (6). At last follow-up (mean, 36 months; range, 12-137 months), every patient had clinical, biologic, and radiographic evaluation.
  
  
  RESULTS
  Infections were largely caused by coagulase-negative staphylococci (56%) and Propionibacterium acnes (59%). The complication rate was 26%. At last follow-up, 26 patients were free of infection (81%). The final Constant score was 46 (12-75). After débridement with implant retention, the mean Constant score was 51 (29-75), but the healing rate was only 54%. Implant revision (1 or 2 stage) led to better functional results than implant removal (46 vs. 25; P = .001), with similar healing rates (73% and 67%, respectively). Patients with low initial impairment (Constant score > 30) were not significantly improved by surgical treatment.
  
  
  CONCLUSIONS
  Débridement is the less aggressive option but exposes patients to healing failure. It should be proposed as a first treatment attempt. Revision of the implant is technically challenging but preserves shoulder function, with no higher rate of residual infection compared with implant removal.
authors.affiliation: Orthopaedic & Traumatologic Surgery Department, Centre Chirurgical E. Gallé, Nancy, France. Electronic address: ad.jacquot@gmail.com.
authors.forename: Adrien
authors.initials: A
authors.lastname: Jacquot
authors.affiliation: Orthopaedic & Traumatologic Surgery Department, Centre Chirurgical E. Gallé, Nancy, France.
authors.forename: François
authors.initials: F
authors.lastname: Sirveaux
authors.affiliation: Orthopaedic & Traumatologic Surgery Department, Centre Chirurgical E. Gallé, Nancy, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Roche
authors.affiliation: Orthopaedic & Traumatologic Surgery Department, Hopital Trousseaux, Tours, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Favard
authors.affiliation: Orthopaedic Surgery and Hand Surgery Center, Illkirch Graffenstaden, Strasbourg, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Clavert
authors.affiliation: Orthopaedic & Traumatologic Surgery Department, Centre Chirurgical E. Gallé, Nancy, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Molé
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000379:methods*; D003646:Debridement; D020878:Device Removal; D005260:Female; D005602:France; D006801:Humans; D007595:Joint Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000601:surgery*
keywords: Infection; complication; débridement; reversed shoulder arthroplasty; reversed shoulder prosthesis; revision; shoulder