Abstract
The current standard of care in the United States for the treatment of an infected arthroplasty, whether it be a TKA, THA or TSA remains two stage revision. We performed a systematic review of the English literature to answer the question of whether one-stage or two-stage revision of infected shoulder arthroplasty was better in terms of re-infection rate, patient satisfaction and patient function. There were no prospective, randomised studies comparing these two approaches. We found 19 studies with a minimum one year follow up which described 99 patients with two-stage revision, 38 with one-stage revision and 36 with spacers. There were no significant differences between the groups for recurrent infection rate or complication rate. The spacer only group had higher satisfaction than the one-stage group, but the satisfaction rate between the one- and two-stage groups was not statistically different.
Unfortunately, the numbers in our study were small and based upon level IV evidence. It is interesting that currently the data do not support two-stage over one-stage revision of an infected TSA. So why do we continue to use two-stage revision? I believe it is the fear of litigation to a certain degree but also historical bias toward two-stage revisions. The only time I would do a one-stage revision is if (1) it is a low virulence organism, (2) the prosthesis can be easily removed and (3) the patient was too sick to tolerate multiple operations.
