Aim: Revision of shoulder replacements in patients with irreparably damaged rotator cuffs and disintegrated coracoacromial arch are typical indications for the Delta-III-prosthesis. The aim of this study was to evaluate the results of one-stage exchange procedures with and without reconstruction of the glenoid (n =21) and compare them with the preoperative status.

Methods: Eighty-four patients who had undergone one-stage prosthesis exchange were included in the prospective analysis. Pain and functional results were recorded using our own specifically compiled follow-up questionnaire and evaluated according to the Constant/Murley Shoulder Score. The indications for exchange surgery were impingement and pain due to cranial dislocation of the prosthesis head in fifty-four cases, cranio-ventral dislocation in nineteen, periprosthetic infection in six, aseptic loosening in four, and postoperative ankylosis of the shoulder with heterotopic ossifications in one case.

Results: The mean age of the patients was 68.1 years (49–82). Prior to our exchange surgery sixteen patients had already undergone one and five patients two exchange procedures with implantation of a standard prosthesis. Thirty-eight patients had had several non-arthroplasty revision operations. After exchange for a Delta prosthesis eighty-three of the patients were pain-free or experienced tolerable pain only when the joint was subjected to a longer period of strain. The Constant/Murley Shoulder Score improved from a mean preoperative value of 27 to 58 points within 36–48 months. The overall complication rate was 13.1%. Bony reconstruction of the glenoid did not appear to have any significant influence on the outcome of the exchange procedure.

Conclusion: Patients’ satisfaction with the result of one-stage exchange of shoulder replacements using inverse implants is high due to the reliable and fast alleviation of pain, the satisfactory function of the joint and the fact that the need for nursing care can be avoided. The almost maximum functional result is already achieved after three months and with continued physiotherapy further gradual improvement is possible up to one year after surgery due to an increase in muscle strength. The outcome may be impaired by impingement at the lower glenoid rim leading to erosion and possible loosening of the component.

This study reviews the predisposing features, the clinical, and laboratory findings at the time of diagnosis and the results of single-stage revision of prosthetic replacement of the elbow for infection.

Deep infection occurred in six of 305 (1.9%) primary total elbow replacements. The mean follow-up after revision was 6.8 years (6 months to 16 years) and the mean age at the time of revision was 62.7 years (56 to 74). All six cases with infection had rheumatoid arthritis and had received steroid therapy. The infective organism was Staphylococcus aureus. Four of the six elbows had a developed radiolucency around one component or the other. Successful single-stage exchange arthroplasty was carried out with antibiotic-loaded cement in five of the six cases. In one, the revision prosthesis had to be removed following recurrence of the infection. The functional result was good in three elbows, fair in one, poor in one and fair in the resection arthroplasty.

Inverse shoulder prosthesis systems are available to compensate for irreparable dysfunction of the rotator cuff. The aim of this study is to evaluate the results after one-stage exchange operations of shoulder implants using the Delta Prosthesis and compare these with the preoperative status.

84 one-stage prosthesis exchanges were evaluated in this prospective analysis 0.5 to 4 years postoperatively. Symptoms of pain and functional results were recorded in a specially compiled follow-up questionnaire and also classified according the Constant and Murley shoulder score.

The mean age of the patients was 65.6 years (49–78 years). The current exchange operation was performed due to impingement caused by cranial migration of the implant head, cranio-ventral dislocation, periprosthetic infection, implant loosening and postoperative ankylosis of the shoulder joint. After the exchage operation with reimplantation of a Delta Prosthesis all patients had complete relief of pain or experienced tolerable pain. The function of the shoulder was markedly improved in all cases. The Constant and Murley shoulder score increased form the preoperative average of 29 to 58 points. The overall complication rate was 13.1%.

One-stage exchange of shoulder prostheses using inverse implants is a technically demanding, but standardised procedure for treating instability, dislocation, limited range of motion, loosening and infection in appropriate cases. The reliable reduction or complete elimination of pain has resulted in a high degree of satisfaction among patients. The final functional result is almost fully achieved as soon as three months postoperatively.

There are few reports in the literature of the diagnosis and treatment of the infected shoulder arthroplasty. Most deal with resection arthroplasty and two-stage exchange surgery. We present our results of one-stage exchange operation as treatment for the infected shoulder arthroplasty.

Our group comprised 16 patients (ten men, six women) with 16 infected arthroplasties. By the time of follow-up, two patients had died (mean 5.8 years), two could not be located and three had already undergone revision surgery. Nine patients were thus available for clinical examination and assessment.

The infections were largely caused by staphylococci, Propionibacterium species and streptococci. Two were early infections (within three months of surgery) and 14 were late infections. The mean follow-up was 5.8 years (13 months to 13.25 years) when the mean Constant-Murley score was 33.6 points and the mean University College of Los Angeles score 18.3 points.

Further revision was performed in three patients. One sustained a peri-prosthetic humeral fracture, another developed an acromial pseudarthrosis after transacromial surgery and the third suffered recurrent dislocations. No patient had a recurrence of infection.

A one-stage exchange procedure using antibiotic-loaded bone cement eradicated infection in all our patients and we suggest that such a procedure is at least as successful as either a resection arthroplasty or a two-stage exchange in the management of the infected shoulder arthroplasty.