ARTHRODESIS OF THE SHOULDER AFTER SEPTIC ARTHRITIS: LONG TERM RESULTS

Abstract

Introduction: Septic glenohumeral destruction is one of the most feared complications after operative fracture care. Unlike for other joints resection arthroplasty is not a possible alternative form of treatment. Our aim in this study was to assess the long-term results of shoulder arthrodesis in 15 patients after septic joint destruction.

Patients and Methods: Between 1978 and 1998 septic arthrodesis of the shoulder was performed in 15 patients. There were four women and 11 men with a mean age of 51.9 years. All patients were asked to return for clinical evaluation in June 2002. Three had died from unrelated causes and one from abroad had been lost for follow up. The outcome was evaluated according to the modified functional score of Hawkins and Neer and David, Makowski and Muhr. We recorded the complications, further operations, alterations in working habits, pain and patient satisfaction.

Results: The mean follow up was 8.3 years (3 to 14y). 3.8 (1 to 14) previous procedures had been performed. The entire 11 pat. were limited using their arm behind their backs. None was able to perform toilet hygiene and only one patient was able to reach his back pocket. Function at the level of the head in order to shave or to comb hair was difficult for the most, whereas nine patients were able to work at waist level. Eight were able to put on shoes and socks. Four were able to climb a ladder. All had had pain before surgery. On visual analogue scale, the mean preoperative level of pain was 7.9 and 3.3 after fusion. Complications occurred in 5 patients. 3 had persistent infection and failure of bony fusion requiring further surgery, one patient with persisting infection denied surgical interventions, one sinus tract healed after hardware removal.

Conclusion: The outcome depends on the individual patient and the indication for arthrodesis. To our knowledge, this is the first study which has investigated the long term results after arthrodesis indicated by septic joint destruction. Heavy tobacco misuse and a high number of previous procedures could be identified as risk factors for persisting of infection, persisting pain and failure of bony fusion with statistical significance.