Published online Oct 18, 2019. doi: 10.5312/wjo.v10.i10.356
Peer-review started: April 4, 2019
First decision: July 31, 2019
Revised: September 3, 2019
Accepted: September 15, 2019
Article in press: September 15, 2019
Published online: October 18, 2019
The usual treatment of septic shoulder arthritis consists of arthroscopic or open lavage and debridement. However, in patients with advanced osteoarthritic changes and/or massive rotator cuff tendon tears, infection eradication can be challenging to achieve and the functional outcome is often not satisfying even after successful infection eradication. In such cases a two-stage approach with initial resection of the native infected articular surfaces, implantation of a cement spacer before final treatment with a total shoulder arthroplasty in a second stage is gaining popularity in recent years with the data in literature however being still limited.
To evaluate the results of a short interval two-stage arthroplasty approach for septic arthritis with concomitant advanced degenerative changes of the shoulder joint.
We retrospectively included five consecutive patients over a five-year period and evaluated the therapeutic management and the clinical outcome assessed by disability of the arm, shoulder and hand (DASH) score and subjective shoulder value (SSV). All procedures were performed through a deltopectoral approach and consisted in a debridement and synovectomy, articular surface resection and insertion of a custom made antibiotic enriched cement spacer. Shoulder arthroplasty was performed in a second stage.
Mean age was 61 years (range, 47-70 years). Four patients had previous surgeries ahead of the septic arthritis. All patients had a surgical debridement ahead of the index procedure. Mean follow-up was 13 mo (range, 6-24 mo). Persistent microbiological infection was confirmed in all five cases at the time of the first stage of the procedure. The shoulder arthroplasties were performed 6 to 12 wk after insertion of the antibiotic-loaded spacer. There were two hemi and three reverse shoulder arthroplasties. Infection was successfully eradicated in all patients. The clinical outcome was satisfactory with a mean DASH score and SSV of 18.4 points and 70% respectively.
Short interval two-stage approach for septic shoulder arthritis is an effective treatment option. It should nonetheless be reserved for selected patients with advanced disease in which lavage and debridement have failed.
Core tip: Shoulder septic arthritis associated with advanced osteoarthritic changes and/or rotator cuff tendon tears is challenging to treat. The classic approach of lavage and debridement is burdened by a higher failure rate with insufficient eradication of the infection and unsatisfactory functional outcomes. A two-stage approach with initial resection of the articular surfaces, implantation of an antibiotic enriched cement spacer before final treatment with a total shoulder arthroplasty is an appealing therapeutic option. Our retrospective case-series of five patients reveals that this approach is effective to eradicate infection and provides a satisfactory clinical outcome.