266. INFECTIONS AFTER REVERTED SHOULDER PROSTHESIS

Abstract

Purpose of the study: Infection is a rare complication of shoulder athroplasty (3% of reverted prostheses), potentially responsive to diverse therapeutic strategies. This work evaluated the clinical and infectious outcomes obtained after management of infectious complications of reverted total shoulder arthroplasty.

Material and methods: This series included 11 reverted shoulder arthroplasties reviewed at mean 39 months. The bacteriological analysis identified predominantly Pro-pionibacterium acnes (54%). Three patients presented an acute infection, five a subacute infection, and three a chronic infection. In this series, six patients underwent a wash-out debridement procedure, two a two-phase reimplantation, and three a one-phase reimplantation.

Results: At last follow-up, three patients died, eight were reviewed. In the wash-out debridement group, one patient developed recurrent infection and two had repeated dislocations; the mean Constant score was 62 points and the ASES score 16/30. In the two-phase reimplantation group, there was no recurrent infection, the spacer broke in one patient, and the mean Constant score was 45 and the ASES score 10/30. In the one-phase reimplantation group, there were no cases of recurrent infection; the mean Constant score was 51 and the ASES score 11.

Discussion: The therapeutic strategy remains a controversial issue for the infected shoulder arthroplasty. Experience with infected knee and hip prostheses is essential. For infected shoulder prostheses, resection was for a long time the advocated solution, allowing cure and pain relief at the cost of major loss of shoulder mobility. Recent series have reported the effect of wash-out, debridement and reimplantation, allowing restoration of function. In the series reported here, the objective was to restore shoulder function as best as possible while achieving cure of the infection.

Conclusion: Although techniques for surgical revision were inspired by experience with the hip and knee, the problems with shoulder infections are different. The unique goal of curing the infection must be revisited. Shoulder function, and in particular range of motion conditioning the functional outcome, should dictate the surgical strategy for these infections.