title: Two-stage revision for infected shoulder arthroplasty.
abstract: BACKGROUND
  Periprosthetic shoulder infections (PSIs) are challenging to treat and often result in significant patient morbidity. Without a standardized treatment protocol, PSIs are often managed similarly to periprosthetic hip and knee infections. Because 2-stage revision is the gold standard for treating periprosthetic hip and knee infections, we performed a case series and literature review to determine its effectiveness in PSIs.
  
  
  METHODS
  We identified 19 patients (14 men) from our institution who were treated with a 2-stage revision after presenting with a PSI. Mean patient age was 63 ± 9 years, and average body mass index was 30.8 ± 5.8. The average time from the index arthroplasty to treatment was 40 months, 8 of 13 positive cultures were Propionibacterium acnes, and 9 of 19 patients had multiple shoulder operations before presenting with infection. Minimum follow-up for all patients was 2 years.
  
  
  RESULTS
  After a mean follow-up of 63 months (range, 25-184 months), 15 of 19 patients in our study were successfully treated for PSI. Average postoperative American Shoulder and Elbow Surgeons (ASES) Shoulder Assessment score was 69 (range, 32-98) and average postoperative forward elevation was significantly increased from 58° to 119° (P < .001). The incidence of recurrent infection was 26%. The rate of noninfection complications was 16%, for a total complication rate of 42%.
  
  
  CONCLUSIONS
  In patients with PSIs, especially those with intractable, chronic infections, a 2-stage revision represents a viable treatment option for eradicating infection and restoring function. However, it is important to recognize the risk of recurrent infection and postoperative complications in this challenging patient population.
authors.affiliation: Department of Orthopaedic Surgery, New York University Langone Medical Center, NYU Hospital for Joint Diseases, New York, NY, USA. Electronic address: Daniel.Buchalter@nyumc.org.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Buchalter
authors.affiliation: Department of Orthopaedic Surgery, New York University Langone Medical Center, NYU Hospital for Joint Diseases, New York, NY, USA.
authors.forename: Siddharth A
authors.initials: SA
authors.lastname: Mahure
authors.affiliation: Department of Orthopaedic Surgery, New York University Langone Medical Center, NYU Hospital for Joint Diseases, New York, NY, USA.
authors.forename: Brent
authors.initials: B
authors.lastname: Mollon
authors.affiliation: Department of Orthopaedic Surgery, New York University Langone Medical Center, NYU Hospital for Joint Diseases, New York, NY, USA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Yu
authors.affiliation: Department of Orthopaedic Surgery, New York University Langone Medical Center, NYU Hospital for Joint Diseases, New York, NY, USA.
authors.forename: Young W
authors.initials: YW
authors.lastname: Kwon
authors.affiliation: Department of Orthopaedic Surgery, New York University Langone Medical Center, NYU Hospital for Joint Diseases, New York, NY, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Zuckerman
mesh_terms: D000368:Aged; D000072228:Arthroplasty, Replacement, Shoulder / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011425:Propionibacterium acnes; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000601:surgery*; D016059:Range of Motion, Articular; D012008:Recurrence; D012086:Reoperation / Q000379:methods*; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery; D000072227:Shoulder Prosthesis / Q000009:adverse effects*
keywords: Total shoulder arthroplasty; literature review; medical comorbidities; periprosthetic infection; reimplantation; two-stage revision