title: Outcomes in the treatment of periprosthetic joint infection after shoulder arthroplasty: a systematic review.
abstract: BACKGROUND
  Although many case series have been published on the treatment of shoulder periprosthetic joint infection (PJI), few provide direct comparison of outcomes. This systematic review synthesizes the available English literature on shoulder PJI to quantify treatment effectiveness.
  
  
  METHODS
  The PubMed and Embase databases were searched in April 2014. Keywords included "shoulder replacement infection" and "shoulder arthroplasty infection." Of 663 titles, 55 manuscripts underwent full-text review after application of exclusion criteria. Thirty articles were finally included.
  
  
  RESULTS
  Propionibacterium acnes was most commonly reported, representing 38.9% of infections, followed by Staphylococcus species. Risk factors for shoulder PJI include previous surgery, increased age, male gender, increased body mass index, and diabetes mellitus. The average white blood cell count in 13 studies was 7472 cells/µL. Ten studies reported a mean erythrocyte sedimentation rate of 27.6 mm/h, whereas 14 studies reported a mean C-reactive protein level of 2.6 mg/dL. P. acnes in intraoperative culture specimens was an independent risk factor for failed treatment for shoulder PJI. When outcomes were pooled, no statistical difference was found in the success rates of 1-stage, 2-stage, or resection arthroplasty revision; each displayed a success rate >90%. However, single-stage revision produced the highest mean Constant score; implant retention resulted in the best range of motion.
  
  
  CONCLUSIONS
  Our data suggest that single-stage revision can be as effective as 2-stage or resection treatments; however, the retrospective nature of these data precluded our ability to control for confounding variables. Future studies on shoulder PJI should involve direct comparisons of 1-stage vs. 2-stage treatment while comparing cost, morbidity, and functional outcomes.
authors.affiliation: Shoulder and Elbow Surgery, The Center for Orthopedic Research and Education, Phoenix, AZ, USA. Electronic address: gnelsonmd@gmail.com.
authors.forename: Gregory N
authors.initials: GN
authors.lastname: Nelson
authors.affiliation: Rothman Institute for Orthopedic Surgery, Sidney Kimmel School of Medicine at Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Davis
authors.affiliation: Rothman Institute for Orthopedic Surgery, Sidney Kimmel School of Medicine at Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Surena
authors.initials: S
authors.lastname: Namdari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001170:Arthritis, Infectious / Q000209:etiology / Q000628:therapy*; D000072228:Arthroplasty, Replacement, Shoulder / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011425:Propionibacterium acnes; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000628:therapy*; D016059:Range of Motion, Articular; D012307:Risk Factors; D012785:Shoulder Joint; D016896:Treatment Outcome; D055815:Young Adult
keywords: 1-stage; 2-stage; Periprosthetic joint infection; resection arthroplasty; revision shoulder arthroplasty