Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Oct 18, 2019; 10(10): 356-363
Published online Oct 18, 2019. doi: 10.5312/wjo.v10.i10.356
Advanced septic arthritis of the shoulder treated by a two-stage arthroplasty
Patrick Goetti, Nicolas Gallusser, Alexander Antoniadis, Diane Wernly, Frédéric Vauclair, Olivier Borens
Patrick Goetti, Nicolas Gallusser, Alexander Antoniadis, Diane Wernly, Frédéric Vauclair, Olivier Borens, Department of orthopedic surgery and traumatology, Lausanne University Hospital and University of Lausanne, Lausanne 1010, Switzerland
Author contributions: Goetti P and Gallusser N designed the study and wrote the manuscript; Antoniadis A and Wernly D compiled the data and reviewed the literature; Vauclair F and Borens O critically reviewed the manuscript.
Institutional review board statement: The need for approval was waived by the institutional ethics committee of Lausanne University Hospital (CER-VD) for retrospective case series including 5 patients or less.
Informed consent statement: Patients were not required to give informed consent because the analysis used anonymous data that were obtained after each patient agreed to treatment by written informed consent.
Conflict-of-interest statement: The authors, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Patrick Goetti, MD, Surgeon, Department of orthopedic surgery and traumatology, Lausanne University Hospital and University of Lausanne, Avenue Pierre-Decker 4, Lausanne 1010, Switzerland.
Telephone: +41-79-5569044 Fax: +41-21-3142755
Received: April 3, 2019
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
Research background

Septic arthritis of the glenohumeral joint is a relatively rare entity representing 3% to 15% of septic arthritis. It can nonetheless lead to major complications such as bone and cartilage destruction if treatment is delayed. Early treatment is therefore mandatory to alleviate pain and restore optimal function. Open or arthroscopic irrigation and debridement associated with targeted intravenous antibiotic therapy is effective to eradicate the infection. 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.

Research motivation

The motivation behind this study was to evaluate 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. While this treatment option is gaining popularity in recent years, the evidence in the literature remains limited.

Research objectives

The available studies which deal with the topic of two-stage revision are focused on infected total shoulder arthroplasty. The results of patients with native advanced septic arthritis which are merged in theses cohorts, with no separate analysis provided for this specific subgroup. The aim of our study was reported our results of a short interval two-stage arthroplasty approach for septic arthritis with concomitant advanced degenerative changes of the shoulder joint.

Research methods

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.

Research results

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.

Research conclusions

Our study indicates that short interval two-stage approach for septic glenohumeral arthritis is a valid alternative treatment option for patient with advanced degenerative condition and/or irreparable rotator cuff tears. The main advantage of this novel approach is that by treating the underlying bony pathology in terms of resecting the arthritic bone the chances of successful infection eradication are increased and at the same time it allows for adequate pain control and improvement of functional outcomes. In our opinion, it should be reserved for selected patients with higher stage of infection, who failed to heal with arthroscopic or open lavage and debridement

Research perspectives

The rising number of shoulder procedures performed in aging population with inherent higher risk factors could potentially lead to a growing number of septic glenohumeral arthritis. Multicenter studies are necessary to achieve a higher case load and evidence regarding these rare indications.