THE USE OF SPACERS IN THE TREATMENT OF INFECTIONS OF THE SHOULDER JOINT

Abstract

Introduction: Despite a multitude of reports detailing the management of infected hips and knees with or without arthroplasty, only little information is available on how to deal with infected shoulders. Besides primary haematogenous infection, the increasing number of surgical procedures (infiltration, arthroscopy, ORIF, total- or hemi arthroplasty) confront the orthopaedic surgeon increasingly with this devastating complication. Our goal is to present our experience with the use of a cement spacer in the treatment of infected shoulder joints.

Material and Methods: Between 1995 and 2005 9 patients were diagnosed with deep shoulder infection. The study includes 5 women and 4 men. The mean age at the time of diagnosis of the infection was 65 years (range, 51–78 years). Only 2 patient had had no prior surgery of the shoulder. 5 patients had an infection of a shoulder arthroplasty and 2 patients had been treated with ORIF for fracture.

All of the patients underwent resection the humeral head or retrieval of the arthroplasty with large debridement followed by implantation of an antibiotic impregnated polymethyl methacrylate spacer. After a mean duration of two months of antibiotics and after normalisation of the CRP a delayed reimplantation of a prosthesis was performed in 6 patients. One patient is awaiting arthroplasty, while two patients are satisfied with the functional result obtained with the spacer and do not want further surgery.

Results: None of the patients developed recurrent infection at an average follow-up time of 36 months. Shoulder function was judged objectively and subjectively to be at least satisfactory in all of the patients.

Conclusions: Staged treatment of infected shoulders using antibiotic impregnated polymethyl methacrylate spacers showed in our small group of patients, good and reproducible results. The individually moulded and fitted spacer filling the joint cavity and restoring the normal anatomy of the shoulder after joint debridement makes secondary procedures much easier. In the cases of exchange prosthetic reconstruction no recurrent infection has been experienced and all of the patients have substantial pain relief and an adequate shoulder function. Based on this experience the authors think that staged treatment and the use of a cement spacer in infected shoulder joints is a valid approach.