2021 ISAKOS Biennial Congress ePoster
Midterm Results Of Two-Stage Revision Surgery For Periprosthetic Shoulder Infection
Stephen C. Weber, MD, San Diego, CA UNITED STATES
Prashant Meshram, MBBS, MS, DNB (Ortho), Dubai, Dubai UNITED ARAB EMIRATES
Edward G. McFarland, Lutherville, MD UNITED STATES
Jorge Rojas Llevano, MD, Bogata, Columbia COLOMBIA
Jacob Joseph, BS, Baltimore, MD UNITED STATES
Uma Srikumaran, MD, MBA, MPH, Columbia, MD UNITED STATES
The Johns Hopkins School of Medicine, Baltimore, MD, UNITED STATES
FDA Status Cleared
Summary
The results of 17 patients with infected TSR treated with two-stage revision was reviewed at a minimum of 5 years.
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Abstract
Aim
To report the reinfection rate and clinical outcomes at a minimum five year follow up in patients with periprosthetic shoulder infection (PSI) treated with two stage revision.
Background
There are no studies of reinfection rates and clinical results at mid-term follow-up after two-stage revision for PSI. The purpose of this study was to determine the reinfection rate and clinical outcomes of two-stage revision for PSI at a minimum follow-up of five years. The secondary aim was to evaluate the application of the new guidelines from the International Consensus Meeting (ICM) in 2018 for diagnosis of PSI in this cohort.
Methods
We identified 17 patients with infection after shoulder arthroplasty between 2005 and 2014 who were treated with a two-stage revision and had a minimum follow-up of five years (range 5 to 9 years). Mean patient age was 64 ± 7 years and 65% were male. The average time from the index arthroplasty to treatment was 40 months. All patients were revised to a RTSA at second stage revision. Complications, visual analogue scale for pain, Simple Shoulder Test, American Shoulder and Elbow Surgeons and Western Ontario Osteoarthritis of the Shoulder scores, and range of motion were noted. Patients were retrospectively scored and categorized using the ICM 2018 diagnostic criteria.
Results
A recurrent infection developed in 3 (18%) of the 17 patients. The cumulative incidence of recurrence of infection was 0% at 1 year, 6% at 2 years and 18% at 5 years. At latest follow-up, patients had a statistically and clinically significant improvement in functional outcomes and range of motion in abduction and forward flexion. Using ICM 2018 criteria at first stage revision surgery, the category of PSI for ten (59%) patients was “Definite PSI”, four (23%) patients was “Probable PSI”, and three (18%) patients was “Possible PSI” (Table 1).
Conclusion
The rate of reinfection after a two-stage revision surgery for PSI at midterm follow up was 18%. The clinical outcomes of patient were favorable in the patients who remained free of infection. The ICM 2018 criteria require further study with larger cohorts of patients.