title: Management of acute or late hematogenous infection after shoulder arthroplasty with irrigation, débridement, and component retention.
abstract: BACKGROUND
  Irrigation and débridement (I&D) with component retention is an appealing alternative to both patients and surgeons for the management of acute or late hematogenous deep periprosthetic shoulder infection (PSI). However, the success rate and results of I&D are poorly documented. This study reports the outcomes and complications of this treatment strategy for acute and delayed-onset acute hematogenous PSI.
  
  
  METHODS
  Between 1980 and 2010, 10 shoulders (9 patients) underwent I&D with component retention for the management on an acute or delayed-onset acute hematogenous PSI at a single institution. Outcome data, including pain, range of motion, need for chronic oral antibiotic suppression therapy, eradication of infection, and need for further surgery were retrospectively collected.
  
  
  RESULTS
  Deep infection recurred in 3 shoulders, which were eventually treated with resection arthroplasty. Of the remaining 6 patients (7 shoulders), 5 were prescribed chronic antibiotic suppression. At the most recent follow-up, pain was graded as none in 3 shoulders, mild in 1, moderate with activity in 3, moderate in 2, and severe in 1. Among shoulders with retained components, forward elevation was greater than 110° in 6 (median, 140°; range, 30°-160°), and external rotation was greater than 40° in all shoulders (median, 50°; range, 40°-90°).
  
  
  CONCLUSIONS
  I&D allowed component retention in 70% of shoulders presenting with an acute or delayed-onset acute hematogenous infection. Most patients were prescribed chronic antibiotic suppression, and reasonable motion was maintained.
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Taylor
authors: T
authors: Dennison
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Eduard
authors: E
authors: Alentorn-Geli
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Andrew T
authors: AT
authors: Assenmacher
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors: John W
authors: JW
authors: Sperling
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Joaquín
authors: J
authors: Sánchez-Sotelo
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA. Electronic address: cofield.robert@mayo.edu.
authors: Robert H
authors: RH
authors: Cofield
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000072228:Arthroplasty, Replacement, Shoulder / Q000009:adverse effects*; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D016059:Range of Motion, Articular; D012008:Recurrence; D012189:Retrospective Studies; D000072227:Shoulder Prosthesis / Q000009:adverse effects*; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: PSI; Shoulder; TSA; deep periprosthetic shoulder infection; hematogenous infection; shoulder arthroplasty