Abstract
Purpose of the study: Infection is a rare complication of shoulder arthroplasty (0–4% according to Cofield). Many therapeutic options are available. Here we evaluated the midterm results obtained after arthroplastic resection used for the treatment of acute or subacute infections.
Material and methods: This series included nine patients (five females and four males) treated by arthroplastic resection. The dominant side was involved in five patients. Mean age at implantation was 63.5 years. The cause was a traumatic event in six cases, the others involving centered osteoarthritic degeneration, with one excentered case and one radiation-induced necrosis. Mean age at removal was 66 years. Mean duration of implantation was 2.39 years. The infection was subacute (two months to one year) in one patient and chronic (longer than one year) in eight. Implants were: cemented seven Aequalis prostheses (four for trauma, two with humerus prosthesis only, one total arthroplasty), one Depuy delta III reversed prosthesis, and one long Neer stem. The mean Constant score was 57.166 and the subjective outcome was considered good in six shoulders, fair in one, and poor in two before the infection-related degradation. Outcome of treatment was assessed clinically (Constant score and subjective assessment), and radiographically. Blood cell counts, erthrocyte sedimentation rate, and C-reactive protein levels were noted preoperatively and at last follow-up. The bacteriological results were available in all cases. Treatment consisted in arthroplastic resection in all nine shoulders, one using a spacer. Mean duration of postoperative antibiotic therapy was four months.
Results: A staphylococcal infection was identified in eight of the nine patients. Intraoperative complications were noted in 20%. Bacteriological cure was achieved in all patients at mean follow-up of four years, but with a significant functional impact (mean Constant score 28 points). Pain relief was satisfactory or very satisfactory in 100%. The subjective outcome was noted fair or poor in eight of the nine patients.
Discussion: Our results are compared with the data in the literature from the two main international series (Cofield, Boileau).
Conclusion: Our technique enabled bacteriological cure in 100% of patients who were all pain free, but at the cost of lost function.
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