Abstract
Septic arthritis of the shoulder or an infected arthroplasty are rare events, but when they do occur present difficult clinical challenges. Little can be found in the existing literature to provide guidance in managing these problems. Certainly early signs of infection are best treated aggressively with irrigation, debridement and appropriate intravenous antibiotic therapy. Early aggressive management can sometimes prevent formal septic arthritis, when a prosthetic implant is well seated may preclude development of deep infection and need for removal.
However, in the face of definitive septic arthritis or sepsis around a prosthetic shoulder implant, aggressive debridement including removal of infected bone, cartilage, and complete removal of prosthetic implants and cement has been shown to be the most reliable means of eradicating infection. Unfortunately, the resultant void leaves the patient with a fairly useless shoulder. Treatment options historically have included resection arthroplasty, late arthrodesis and more recently late attempts at prosthetic reconstruction.
Eight patients have been treated with staged exchange prosthetic replacement utilising tobramycin impregnated methacrylate spacers, shaped and fitted to the patient’s anatomy at the time of extensive debridement. Intravenous antibiotic therapy followed for a minimum of three months. At the end of six months the patients were evaluated for any clinical or laboratory signs of infection. When none were encountered, exchange prosthetic reconstruction was performed utilising standard implants fixed with antibiotic impregnated methyl methacrylate cement. There were three primary infections, (one following rotator cuff surgery) and five patients with infected total shoulder or hemiarthroplasties. Organisms included staph aureus in six patients and staph epidermatitis in two. No organism was methacillin resistant. Three patients had a revision to a total shoulder arthroplasty while five underwent hemiarthroplasty of the humerus with local capsular flap fascial covering of the glenoid.
All eight patients demonstrated substantial pain relief and improvement in function. Motion in all cases was significantly limited with total overhead elevation averaging approximately 70° with only one patient achieving 120°.
Staged exchange prosthetic replacement of the shoulder appears to be a satisfactory salvage procedure for managing sepsis both primarily and following shoulder arthroplasty with evidence of good pain relief but with significant limitations in motion and strength.
The abstracts were prepared by Mrs Dorothy L. Granchi, Course Coordinator. Correspondence should be addressed to her at PMB 295, 8000 Plaza Boulevard, Mentor, Ohio 44060, USA.
