Surgical management of periprosthetic shoulder infections.
BACKGROUND
The treatment of periprosthetic joint infection is a difficult challenge in shoulder arthroplasty. This study investigated 1-stage modular component exchange vs. 1-stage complete removal and reimplantation (CRR) vs. 2-stage revision arthroplasty for periprosthetic joint infection.


METHODS
Between January 1, 2004, and December 31, 2012, 79 patients received a component exchange (n = 15), CRR (n = 45), or a 2-stage (n = 19) revision for infection. A binary logistic regression analysis was performed to determine factors presenting the greatest risk of reinfection. Complications and functional outcomes were also evaluated.


RESULTS
Overall, 4 of 15 (27%) component exchanges, 2 of 45 (4%) CRRs, and 4 of 19 (21%) 2-stage procedures required a reoperation for infection with a minimum of 1 year of follow-up. The difference between the CRR group and exchange group was significant (P = .030); however, the difference between the CRR group and 2-stage group did not reach statistical significance (P = .059). No preoperative and intraoperative selection bias between the groups was found. Binary logistic regression predicted that reinfection was highest in patients whose cultures grew Staphylococcus aureus (P = .004) or coagulase-negative Staphylococcus species (P = .041) or those treated with a component exchange (P = .015). The difference between groups for noninfection-related complications was not significant (P = .703). All procedures provided improved functional outcomes and pain relief.


CONCLUSIONS
Patients with infection caused by Staphylococcus aureus or coagulase-negative Staphylococcus species may require additional operations to treat the infection. Although effective in some cases, component exchange presents an increased risk for reinfection. A 1-stage CRR procedure had similar reinfection rates as a 2-stage procedure in our patient population.
Houma Orthopedic Clinic, Houma, LA, USA.
Geoffrey P
GP
Stone
Foundation for Orthopaedic Research and Education, Clinical Research, Tampa, FL, USA.
Rachel E
RE
Clark
Foundation for Orthopaedic Research and Education, Clinical Research, Tampa, FL, USA.
Kathleen C
KC
O'Brien
Foundation for Orthopaedic Research and Education, Clinical Research, Tampa, FL, USA.
Lisa
L
Vaccaro
Foundation for Orthopaedic Research and Education, Clinical Research, Tampa, FL, USA.
Peter
P
Simon
Countryside Orthopaedics, Leesburg, VA, USA.
Adam J
AJ
Lorenzetti
Health First Medical Group, Melbourne, FL, USA.
Brent C
BC
Stephens
Florida Orthopaedic Institute, Shoulder and Elbow Service, Tampa, FL, USA. Electronic address: mfrankle@floridaortho.com.
Mark A
MA
Frankle
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000072228:Arthroplasty, Replacement, Shoulder; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D026741:Physical Therapy Modalities; D011183:Postoperative Complications / Q000601:surgery; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012086:Reoperation; D013203:Staphylococcal Infections / Q000601:surgery*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D016896:Treatment Outcome
1-stage shoulder arthroplasty; 2-stage shoulder arthroplasty; component exchange; periprosthetic shoulder infection; reverse shoulder arthroplasty; shoulder infections