Background
Shoulder arthroplasty is an option for the management of the sequelae of native shoulder joint infections, however currently the functional outcomes, risks and re-infection rates in this patient group are unknown. The aim of this systematic review was to analyse the outcome of shoulder arthroplasty in patients with native shoulder infections.
Methods
A systematic review of the literature was conducted in accordance with the PRISMA guidelines using the Pubmed and the Cochrane database. The review was registered on the PROSPERO database prospectively. Studies reporting on adults with either primary or secondary infections of their native shoulder joints treated with a spacer, hemiarthroplasty (HA), total shoulder arthroplasty (TSA) or reverse shoulder arthroplasty (RSA) were included. Clinical studies were appraised using the MINORS tool.
Results
14 studies were deemed eligible for inclusion (n=136). Mean age of patients ranged from 56 to 72 years and the mean follow up from 20.5 months to 8.2 years. Primary shoulder infections were present in 50 patients and secondary infections in 86: previous rotator cuff repair (n=49), previous fracture fixation (n=27) and other arthroscopy surgery (n=10). The commonest causative micro-organisms were Methicillin sensitive staphylococcus aureus 12- 91%, coagulase negative staphylococcus 7-38%, Cutibacterium acnes 9-40% and Staphylococcus epidermidis 18-57%. 76 patients underwent a 2 stage, 46 patients a single stage procedure whilst 14 refused second stage surgery. Mean post-operative Constant score ranged from 38 to 56.2 and mean ASES scores from 57.6 to 78.4. The overall reported re- infection rate was 2.3% and complication rate was 26% with loosening, instability and fractures the most frequent complications encountered.
Conclusion
Shoulder arthroplasty in the management of primary or secondary native shoulder joint infection is a viable option but has a high complication rate of 26% and relatively poor functional outcome. While the re-infection rates are low at short term follow-up, longer term studies are required to ensure these re-infection rates remain low and functional outcomes are maintained in this challenging patient population.