|Beitragstitel||Treatment Of Periprosthetic Shoulder Infections Using Antibiotic Loaded Cement Spacer|
The treatment of periprosthetic shoulder infections (PSI) with two-stage revision arthroplasty using an antibiotic loaded cement spacer is beside the single-stage revision the most common strategy to successfully treat low-grade infections. Nevertheless, the available data about restoration of shoulder function after cement spacer treatment is scarce. This study aimed to analyze the eradication rate of infection and the functional shoulder restoration after two-stage revision arthroplasties using antibiotic cement spacer.
We retrospectively searched for patients with a PSI treated with a 2-stage exchange using an antibiotic spacer between 2000 and 2013.
The infection eradication rate 2 years after reimplantation was assessed as the primary endpoint and the clinical outcome obtained with the Constant and Murley Score, the patient satisfaction and the subjective shoulder value at the last follow-up visit was defined as the secondary endpoint.
Between January 2000 and December 2013 48 patients underwent a two-stage revision arthroplasty using an antibiotic loaded cement spacer. 10 patients were lost to clinical follow up. The infection eradication rate was 95%. The complication rate was 58% and the revision surgery rate 38%. In patients who were definitely treated with RTSA (n=23) the CS and RCS improved the most from 31 (2-81) to 51 (14-78) points and from 37 (2-95) to 61 (18-100) % (p<0.01). Those, who were treated with HA (n=6) improved from 22 (7-42) to 24 (11-33) points respectively from 25 (9-45) to 28 (13-45) % and those, where the spacer was left in place (n=9) had a final CS / RCS of 35 (23-45) and 42 (29-59) %. Patients with a 2-stage revision with a definitive reimplantation of a RTSA with 5 or more surgeries before the 2-stage revision showed a significantly lower mean CS.
Conclusion: The infection eradication rate of periprosthetic shoulder joint infection after the use of an antibiotic loaded cement spacer is 95% in our cohort.
Two-stage revision with re-implantation of a RTSA allows the best restoration of shoulder function in our series. Multiple prior surgical interventions worsen the functional outcome of patients with a reimplantation of a RTSA.