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Saccomanno MF, Lädermann A, Collin P. Two-Stage Exchange Arthroplasty for Periprosthetic Reverse Shoulder Arthroplasty Infection Provides Comparable Functional Outcomes to Primary Reverse Shoulder Arthroplasty. J Clin Med 2024; 13:904. [PMID: 38337598 PMCID: PMC10856729 DOI: 10.3390/jcm13030904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/15/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
This study aimed to compare functional outcomes after two-stage revision reverse shoulder arthroplasty (RSA) for periprosthetic joint infection (PJI) with the results of primary RSA. Patients affected by PJI and treated by means of two-stage revision RSA were 1:1 matched with a group of patients who were treated electively with RSA without developing any complications. Out of 1477 RSAs performed between 2009 and 2021, 16 patients developed a PJI. Each matched cohort comprised 16 patients (3 females, 13 males). The mean age was 69.13 ± 5.43 years old in the PJI group and 70.28 ± 5.04 (p = 0.543) in the matched cohort. The mean follow-up was 41.23 ± 26.9 months in the PJI group and 28.5 ± 20.2 (p = 0.142) in the matched group. Only one patient showed recurrent PJI five years after revision RSA. Comparison between the PJI patients and matched patients did not show any significant differences at the latest follow-up, nor for subjective shoulder value (SSV) (p = 0.101) or Constant score (p = 0.134). Two-stage exchange RSA for PJI allows for appropriate control of the disease and good functional outcomes. Comparison with an age- and sex-matched cohort of uninfected patients showed no significant differences, thus confirming the idea that revision surgeries may lead to satisfactory functional outcomes, as expected after primary surgery.
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Affiliation(s)
- Maristella Francesca Saccomanno
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy;
- Department of Bone and Joint Surgery, Spedali Civili, 25123 Brescia, Italy
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, Hôpital de La Tour, Rue J.-D. Maillard 3, 1217 Meyrin, Switzerland
- Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211 Geneva, Switzerland
| | - Philippe Collin
- CHP Saint-Gregoire, 6 Boulevard de la Boutière, 35760 Saint-Grégoire, France;
- Clinique Victor Hugo, 5 Bis Rue du Dôme, 75016 Paris, France
- American Hospital of Paris, 55 Boulevard du Château, 92200 Neuilly-sur-Seine, France
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Fiore M, Ferra L, Giannini C, Sambri A, Filippini M, Tedeschi S, Zamparini E, Viale P, De Paolis M, Guerra E. Management of periprosthetic joint infection of shoulder arthroplasty: Single-stage versus two-stage protocols. A systematic review and meta-analysis of the literature. Shoulder Elbow 2023; 15:25-40. [PMID: 37692869 PMCID: PMC10492529 DOI: 10.1177/17585732221116839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 09/12/2023]
Abstract
Background The treatment of shoulder prosthetic joint infections (PJIs) requiring removal of the prosthesis is not well defined. This article aims to systematically review and compare the results of the literature in single-stage and two-stage protocols in the treatment of shoulder PJI. Methods An in-depth search on PubMed/Scopus/Web of Science databases and cross-referencing search was carried out concerning the articles reporting detailed data on the topic. Results A total of 486 shoulder PJIs were included: 137 treated with single-stage and 349 with two-stage procedure. A similar distribution between early and not-early infections (19.1% vs 80.9%) was found between the two groups. The overall rate of success in terms of PJI eradication was significantly higher in the single-stage group (95.6% vs 85.7%, p < 0.001). The non-infection-related complications rate was 13.8% in the single-stage group and 37.6% in the two-stage group (p < 0.001), the non-infection-related revision rate was 8% and 18.9%, respectively (p = 0.005). Discussion The single-phase protocol showed a higher success rate in eradicating the infection and a lower complication rate. However, the low number of patients included, the low quality of the articles, the lack of data on clinical severity and bacteriological virulence suggest caution in conclusions.
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Affiliation(s)
- Michele Fiore
- Alma Mater Studiorum – University of Bologna, Bologna, Italy
| | - Lorenzo Ferra
- Alma Mater Studiorum – University of Bologna, Bologna, Italy
| | | | - Andrea Sambri
- Alma Mater Studiorum – University of Bologna, Bologna, Italy
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Sara Tedeschi
- Infectious Disease Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Eleonora Zamparini
- Infectious Disease Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Infectious Disease Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Massimiliano De Paolis
- Orthopedics and Traumatology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Enrico Guerra
- Shoulder & Elbow Surgery Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Bota O, Dragu A, Bönke F, Tille E, Taqatqeh F, Nowotny J. Complex Functional Posttraumatic Shoulder Reconstruction Using Shoulder Arthroplasty and a Pedicled Innervated Latissimus Dorsi Flap-A Case Report and Literature Review. Orthop Surg 2023; 15:2181-2186. [PMID: 36411538 PMCID: PMC10432418 DOI: 10.1111/os.13575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 10/09/2022] [Accepted: 10/11/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The shoulder joint is one of the most freely movable joints in the human body and has therefore high importance for upper limb functionality. Several techniques have been developed to replace the glenohumeral joint including humeral hemiarthroplasty, anatomical total shoulder arthroplasty, and reverse total shoulder arthroplasty, depending on the underlying pathology. For the soft tissue reconstruction, the innervated latissimus dorsi musculocutaneous flap is a reliable solution flap in shoulder and arm reconstruction. CASE PRESENTATION We present the case of a 16-year-old male patient with a complete destruction of the shoulder joint and soft tissues after ballistic trauma. We performed the reconstruction of the shoulder joint using a humeral hemiarthroplasty with a mesh fixation to the remaining glenoid. The soft tissue coverage and the restoration of the deltoid muscle function were insured with a pedicled innervated latissimus dorsi musculocutaneous flap. One year postoperatively, the patient showed a good function of the shoulder joint with an excellent aesthetical result and no pain. CONCLUSION The pedicled latissimus dorsi musculocutaneous flap can safely restore the shoulder function, while the humeral hemiarthroplasty with mesh fixation can be a reliable solution for the reconstruction of a completely destructed shoulder joint.
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Affiliation(s)
- Olimpiu Bota
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav CarusTU DresdenDresdenGermany
| | - Adrian Dragu
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav CarusTU DresdenDresdenGermany
| | - Florian Bönke
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav CarusTU DresdenDresdenGermany
| | - Eric Tille
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav CarusTU DresdenDresdenGermany
| | - Feras Taqatqeh
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav CarusTU DresdenDresdenGermany
| | - Jörg Nowotny
- University Center for Orthopedics, Trauma and Plastic Surgery, Faculty of Medicine Carl Gustav CarusTU DresdenDresdenGermany
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Markes AR, Bigham J, Ma CB, Iyengar JJ, Feeley BT. Preventing and Treating Infection in Reverse Total Shoulder Arthroplasty. Curr Rev Musculoskelet Med 2023:10.1007/s12178-023-09843-1. [PMID: 37227587 PMCID: PMC10382412 DOI: 10.1007/s12178-023-09843-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE OF REVIEW Periprosthetic infection after shoulder arthroplasty is relatively uncommon though associated with severe long-term morbidity when encountered. The purpose of the review is to summarize the recent literature regarding the definition, clinical evaluation, prevention, and management of prosthetic joint infection after reverse shoulder arthroplasty. RECENT FINDINGS The landmark report generated at the 2018 International Consensus Meeting on Musculoskeletal Infection has provided a framework for diagnosis, prevention, and management of periprosthetic infections after shoulder arthroplasty. Shoulder specific literature with validated interventions to reduce prosthetic joint infection is limited; however existing literature from retrospective studies and from total hip and knee arthroplasty allows us to make relative guidelines. One and two-stage revisions seem to demonstrate similar outcomes; however, no controlled comparative studies exist limiting the ability to make definitive recommendations between the two options. We report on recent literature regarding the current diagnostic, preventative, and treatment options for periprosthetic infection after shoulder arthroplasty. Much of the literature does not distinguish between anatomic and reverse shoulder arthroplasty, and further high-level shoulder specific studies are needed to answer questions generated from this review.
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Affiliation(s)
- Alexander R Markes
- Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens Street, San Francisco, CA, 94158, USA.
| | - Joseph Bigham
- Department of Orthopaedic Surgery, University of Washington, Seattle, WA, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens Street, San Francisco, CA, 94158, USA
| | | | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California-San Francisco, 1500 Owens Street, San Francisco, CA, 94158, USA
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Cai Y, Huang C, Chen X, Chen Y, Huang Z, Zhang C, Zhang W, Fang X. The role of Staphylococcus aureus small colony variants in intraosseous invasion and colonization in periprosthetic joint infection. Bone Joint Res 2022; 11:843-853. [PMID: 36453022 PMCID: PMC9792874 DOI: 10.1302/2046-3758.1112.bjr-2021-0590.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
AIMS This study aimed to explore the role of small colony variants (SCVs) of Staphylococcus aureus in intraosseous invasion and colonization in patients with periprosthetic joint infection (PJI). METHODS A PJI diagnosis was made according to the MusculoSkeletal Infection Society (MSIS) for PJI. Bone and tissue samples were collected intraoperatively and the intracellular invasion and intraosseous colonization were detected. Transcriptomics of PJI samples were analyzed and verified by polymerase chain reaction (PCR). RESULTS SCVs can be isolated from samples collected from chronic PJIs intraoperatively. Transmission electron microscopy (TEM) and immunofluorescence (IF) showed that there was more S. aureus in bone samples collected from chronic PJIs, but much less in bone samples from acute PJIs, providing a potential mechanism of PJI. Immunofluorescence results showed that SCVs of S. aureus were more likely to invade osteoblasts in vitro. Furthermore, TEM and IF also demonstrated that SCVs of S. aureus were more likely to invade and colonize in vivo. Cluster analysis and principal component analysis (PCA) showed that there were substantial differences in gene expression profiles between chronic and acute PJI. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis showed that these differentially expressed genes were enriched to chemokine-related signal pathways. PCR also verified these results. CONCLUSION Our study has shown that the S. aureus SCVs have a greater ability to invade and colonize in bone, resulting in S. aureus remaining in bone tissues long-term, thus explaining the pathogenesis of chronic PJI.Cite this article: Bone Joint Res 2022;11(12):843-853.
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Affiliation(s)
- Yuanqing Cai
- Department of Orthopaedics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Department of Orthopaedics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi'an, China,Department of Orthopedic Surgery, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Changyu Huang
- Department of Orthopaedics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Department of Orthopedic Surgery, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xiaoqing Chen
- Department of Orthopaedics, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China
| | - Yang Chen
- Department of Orthopaedics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Department of Orthopedic Surgery, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Zida Huang
- Department of Orthopaedics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Department of Orthopedic Surgery, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Chaofan Zhang
- Department of Orthopaedics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Department of Orthopedic Surgery, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Wenming Zhang
- Department of Orthopaedics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Department of Orthopedic Surgery, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xinyu Fang
- Department of Orthopaedics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China,Department of Orthopedic Surgery, First Affiliated Hospital, Fujian Medical University, Fuzhou, China, Xinyu Fang. E-mail:
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Two-Stage Exchange Arthroplasty for Periprosthetic Shoulder Infection Is Associated with High Rate of Failure to Reimplant and Mortality. J Clin Med 2021; 10:jcm10215186. [PMID: 34768706 PMCID: PMC8584704 DOI: 10.3390/jcm10215186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 10/30/2021] [Accepted: 11/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Patients with a periprosthetic joint infection (PJI) of the shoulder, who fail to undergo reimplantation in an attempted two-stage exchange seem to be neglected in the current literature. The aim of this study was to assess the clinical course of patients after the first stage in the process of an attempted two-stage exchange for shoulder PJI. Methods: After a retrospective review of our institutional database between 2008 and 2018, 49 patients, who were treated with an intended two-stage exchange for shoulder PJI, were identified. Patients’ demographics, laboratory and health status parameters, along with records of clinical outcome were collected. The primary outcome measurements analyzed were infection eradication, successful reimplantation, and patient survival. Results: Reimplantation was completed in only 35 (71%) of 49 cases and eradication of infection was achieved in 85.7% of patients with successful reimplantation after a mean follow-up duration of 5.1 years (1.1 to 10.2 years). Reasons for failure to reimplant were premature death in 36%, high general morbidity in 29%, satisfaction with the current status in 21%, or severe infection with poor bone and soft tissues in 14% of the patients. Of the 14 cases without reimplantation, eradication rate of infection was 57% after a mean follow-up of 5 years (2.6 to 11 years). The overall mortality rate of the entire cohort was 25% at the latest follow-up and 10% within ninety days after implant removal. Patients who deceased or did not undergo reimplantation during the follow-up were significantly older and had a significantly higher Charlson comorbidity index (CCI). Conclusions: While the two-stage exchange arthroplasty can lead to high rates of infection eradication, a considerable subset of patients never undergoes the second stage for a variety of reasons. Shoulder PJI and its treatment are associated with a high risk of mortality, especially in patients with older age and higher CCI.
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7
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Lemmens L, Geelen H, Depypere M, De Munter P, Verhaegen F, Zimmerli W, Nijs S, Debeer P, Metsemakers WJ. Management of periprosthetic infection after reverse shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:2514-2522. [PMID: 33895302 DOI: 10.1016/j.jse.2021.04.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/29/2021] [Accepted: 04/04/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Periprosthetic shoulder infection (PSI) remains a devastating complication after reverse shoulder arthroplasty (RSA). Currently, scientific data related to the management of PSI are limited, and the optimal strategy and related clinical outcomes remain unclear. Guidelines from the Infectious Diseases Society of America for the management of periprosthetic joint infection are mainly based on data from patients after hip and knee arthroplasty. The aim of this study was to evaluate whether these guidelines are also valid for patients with PSI after RSA. In addition, the functional outcome according to the surgical intervention was assessed. METHODS An RSA database was retrospectively reviewed to identify infections after primary and revision RSAs, diagnosed between 2004 and 2018. Data collected included age, sex, indication for RSA, causative pathogen, surgical and antimicrobial treatment, functional outcome, and recurrence. RESULTS Thirty-six patients with a PSI were identified. Surgical treatment was subdivided into débridement and implant retention (DAIR) (n = 6, 17%); 1-stage revision (n = 1, 3%); 2-stage revision (n = 16, 44%); multiple-stage revision (>2 stages) (n = 7, 19%); definitive spacer implantation (n = 2, 6%); and resection arthroplasty (n = 4, 11%). The most common causative pathogens were Staphylococcus epidermidis (n = 11, 31%) and Cutibacterium acnes (n = 9, 25%). Recurrence was diagnosed in 4 patients (11%), all of whom were initially treated with a DAIR approach. The median follow-up period was 36 months (range, 24-132 months). CONCLUSION PSI is typically caused by low-virulence pathogens, which often are diagnosed with a delay, resulting in chronic infection at the time of surgery. Our results indicate that treatment of patients with chronic PSI with DAIR has a high recurrence rate. In addition, implant exchange (ie, 1- and 2-stage exchange) does not compromise the functional result as compared with implant retention. Thus, patients with chronic PSI should be treated with implant exchange. Future research should further clarify which surgical strategy (ie, 1-stage vs. 2-stage exchange) has a better outcome overall.
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Affiliation(s)
- Laura Lemmens
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Hans Geelen
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Melissa Depypere
- Department of Clinical Biology, University Hospitals Leuven, Leuven, Belgium
| | - Paul De Munter
- Department of Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Filip Verhaegen
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Werner Zimmerli
- Interdisciplinary Unit for Orthopaedic Infections, Kantonsspital Baselland, Liestal, Switzerland
| | - Stefaan Nijs
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, University of Leuven, Leuven, Belgium
| | - Philippe Debeer
- Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, University of Leuven, Leuven, Belgium
| | - Willem-Jan Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, University of Leuven, Leuven, Belgium.
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Bdeir M, Dally FJ, Assaf E, Gravius S, Mohs E, Hetjens S, Darwich A. Periprosthetic Infections of the Shoulder Joint: Characteristics and 5-Year Outcome of a Single-Center Series of 19 Cases. Antibiotics (Basel) 2021; 10:antibiotics10091125. [PMID: 34572707 PMCID: PMC8471027 DOI: 10.3390/antibiotics10091125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022] Open
Abstract
Periprosthetic shoulder infection (PSI) remains a devastating complication after total shoulder arthroplasty (TSA). Furthermore, there is a paucity in the literature regarding its diagnostic and therapeutic management, especially the absence of therapy concepts devised exclusively for PSI. The aim of the presenting study is to examine the characteristics and outcome of patients with PSI who were treated according to well-established algorithms developed originally for periprosthetic joint infection (PJI) of the hip and knee and determine if these algorithms can be applied to PSI. This single-center case series included all patients with a PSI presenting between 2010 and 2020. Recorded parameters included age, sex, affected side, BMI, ASA score, Charlson comorbidity index, preoperative anticoagulation, indication for TSA (fracture, osteoarthritis or cuff-arthropathy), and type of infection (acute or chronic PSI). The outcome was divided into treatment failure or infect resolution. Staphylococcus epidermidis and aureus were the commonest infecting pathogens. Acute PSI was mainly treated with debridement, irrigation, and retention of the prosthesis (DAIR) and chronic cases with two/multiple-stage exchange. The treatment failure rate was 10.5%. C-reactive protein was preoperatively elevated in 68.4% of cases. The mean number of operative revisions was 3.6 ± 2.6, and the mean total duration of antibiotic treatment was 72.4 ± 41.4 days. The most administered antibiotic was a combination of clindamycin and fluoroquinolone. In summary, the data of the current study suggest that therapeutical algorithms and recommendations developed for the treatment of PJI of the hip and knee are also applicable to PSI.
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Affiliation(s)
- Mohamad Bdeir
- Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (M.B.); (F.-J.D.); (E.A.); (S.G.); (E.M.)
| | - Franz-Joseph Dally
- Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (M.B.); (F.-J.D.); (E.A.); (S.G.); (E.M.)
| | - Elio Assaf
- Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (M.B.); (F.-J.D.); (E.A.); (S.G.); (E.M.)
| | - Sascha Gravius
- Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (M.B.); (F.-J.D.); (E.A.); (S.G.); (E.M.)
| | - Elisabeth Mohs
- Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (M.B.); (F.-J.D.); (E.A.); (S.G.); (E.M.)
| | - Svetlana Hetjens
- Institute of Medical Statistics and Biomathematics, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany;
| | - Ali Darwich
- Department of Orthopaedic and Trauma Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; (M.B.); (F.-J.D.); (E.A.); (S.G.); (E.M.)
- Correspondence: ; Tel.: +49-621-383-6006
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9
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Henry TW, Entezari V, Ghoraishian M, Williams GR, Namdari S. Complications Associated With Intravenous Antibiotic Treatment for Cutibacterium acnes Periprosthetic Shoulder Infection. Orthopedics 2021; 44:e422-e426. [PMID: 34039208 DOI: 10.3928/01477447-20210414-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Whether positive Cutibacterium acnes cultures during revision shoulder arthroplasty represent true periprosthetic joint infection (PJI), deep tissue inoculant, or laboratory contaminant is a point of substantial controversy. The purpose of this study was to review complications of intravenous antibiotics used for treatment of presumed C acnes shoulder PJI. A study population of 26 patients treated for C acnes PJI with a minimum follow-up of 2 years after operative treatment was established. Complication occurrence and severity were obtained through chart review and phone survey. Sixteen (61.5%) patients experienced a therapeutic complication. Twelve (46.2%) patients experienced a total of 47 antibiotic-associated adverse effects and 10 (38.5%) patients experienced 11 total peripherally inserted central catheter line-associated complications. Female sex carried an increased risk for severe complications (relative risk, 3.3; 95% CI, 1.2-9.5; P=.024). Treatment duration of greater than 6 weeks was a significant predictor for the total number of complications experienced [F(1,23)=5.361; P=.030; adjusted R2=0.189]. Age older than 65 years, treatment duration greater than 6 weeks, and female sex were significant predictors for the number of severe complications [F(3,21)=3.249; P=.042; adjusted R2=0.219]. Treating C acnes infection with intravenous antibiotics carries a substantial risk of adverse events, highlighting the importance of accurate diagnosis of shoulder PJI. Further investigations into the efficacy and safety profile of oral antibiotics for shoulder PJI are necessary. [Orthopedics. 2021;44(3):e422-e426.].
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10
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Vilchez HH, Escudero-Sanchez R, Fernandez-Sampedro M, Murillo O, Auñón Á, Rodríguez-Pardo D, Jover-Sáenz A, del Toro MD, Rico A, Falgueras L, Praena-Segovia J, Guío L, Iribarren JA, Lora-Tamayo J, Benito N, Morata L, Ramirez A, Riera M. Prosthetic Shoulder Joint Infection by Cutibacterium acnes: Does Rifampin Improve Prognosis? A Retrospective, Multicenter, Observational Study. Antibiotics (Basel) 2021; 10:antibiotics10050475. [PMID: 33919103 PMCID: PMC8143127 DOI: 10.3390/antibiotics10050475] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/13/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023] Open
Abstract
This retrospective, multicenter observational study aimed to describe the outcomes of surgical and medical treatment of C. acnes-related prosthetic joint infection (PJI) and the potential benefit of rifampin-based therapies. Patients with C. acnes-related PJI who were diagnosed and treated between January 2003 and December 2016 were included. We analyzed 44 patients with C. acnes-related PJI (median age, 67.5 years (IQR, 57.3-75.8)); 75% were men. The majority (61.4%) had late chronic infection according to the Tsukayama classification. All patients received surgical treatment, and most antibiotic regimens (43.2%) included β-lactam. Thirty-four patients (87.17%) were cured; five showed relapse. The final outcome (cure vs. relapse) showed a nonsignificant trend toward higher failure frequency among patients with previous prosthesis (OR: 6.89; 95% CI: 0.80-58.90) or prior surgery and infection (OR: 10.67; 95% IC: 1.08-105.28) in the same joint. Patients treated with clindamycin alone had a higher recurrence rate (40.0% vs. 8.8%). Rifampin treatment did not decrease recurrence in patients treated with β-lactams. Prior prosthesis, surgery, or infection in the same joint might be related to recurrence, and rifampin-based combinations do not seem to improve prognosis. Debridement and implant retention appear a safe option for surgical treatment of early PJI.
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Affiliation(s)
- Helem H. Vilchez
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases, Fundació Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain;
- Correspondence: ; Tel.: +34-653419331
| | - Rosa Escudero-Sanchez
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
| | - Marta Fernandez-Sampedro
- Infectious Diseases Unit, Department of Medicine, Hospital Universitario Marqués de Valdecilla-IDIVAL, 39008 Cantabria, Spain;
| | - Oscar Murillo
- Infectious Diseases Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain;
| | - Álvaro Auñón
- Bone and Joint Infection Unit, Department of Orthopaedic Surgery, IIS-Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Dolors Rodríguez-Pardo
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain;
| | - Alfredo Jover-Sáenz
- Unit of Nosocomial Infection, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain;
| | - Mª Dolores del Toro
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena CSIC, Instituto de Biomedicina de Sevilla (IBiS), Universidad de Sevilla, 41009 Sevilla, Spain;
| | - Alicia Rico
- Infectious Diseases Unit and Clinical Microbiology, Hospital Universitario La Paz, 28046 Madrid, Spain;
| | - Luis Falgueras
- Infectious Diseases Department, Corporació Sanitària Parc Taulí, 08208 Barcelona, Spain;
| | - Julia Praena-Segovia
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospital Virgen del Rocio, 41013 Sevilla, Spain;
| | - Laura Guío
- Infectious Diseases Department, Hospital Universitario Cruces, 48903 Vizcaya, Spain;
| | - José A. Iribarren
- Infectious Diseases Department, Hospital Universitario Donostia, Instituto BioDonostia, 20014 San Sebastián, Spain;
| | - Jaime Lora-Tamayo
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre “i + 12”, 28041 Madrid, Spain;
| | - Natividad Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau-Institut d’Investigació Biomèdica Sant Pau, Departament of Medicine, Universitat Autònoma de Barcelona, 08041 Barcelona, Spain;
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, 08036 Barcelona, Spain;
| | - Antonio Ramirez
- Microbiologic Department, Hospital Universitari Son Espases, 07120 Palma de Mallorca, Spain;
| | - Melchor Riera
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases, Fundació Institut d’Investigació Sanitària Illes Balears (IdISBa), 07120 Palma de Mallorca, Spain;
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Voss A, Pfeifer CG, Kerschbaum M, Rupp M, Angele P, Alt V. Post-operative septic arthritis after arthroscopy: modern diagnostic and therapeutic concepts. Knee Surg Sports Traumatol Arthrosc 2021; 29:3149-3158. [PMID: 33755737 PMCID: PMC8458194 DOI: 10.1007/s00167-021-06525-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/26/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Septic arthritis is a significant complication following arthroscopic surgery, with an estimated overall incidence of less than 1%. Despite the low incidence, an appropriate diagnostic and therapeutic pathway is required to avoid serious long-term consequences, eradicate the infection, and ensure good treatment outcomes. The aim of this current review article is to summarize evidence-based literature regarding diagnostic and therapeutic options of post-operative septic arthritis after arthroscopy. METHODS Through a literature review, up-to-date treatment algorithms and therapies have been identified. Additionally, a supportive new algorithm is proposed for diagnosis and treatment of suspected septic arthritis following arthroscopic intervention. RESULTS A major challenge in diagnostics is the differentiation of the post-operative status between a non-infected hyperinflammatory joint versus septic arthritis, due to clinical symptoms, (e.g., rubor, calor, or tumor) can appear identical. Therefore, joint puncture for microbiological evaluation, especially for fast leukocyte cell-count diagnostics, is advocated. A cell count of more than 20.000 leukocyte/µl with more than 70% of polymorphonuclear cells is the generally accepted threshold for septic arthritis. CONCLUSION The therapy is based on arthroscopic or open surgical debridement for synovectomy and irrigation of the joint, in combination with an adequate antibiotic therapy for 6-12 weeks. Removal of indwelling hardware, such as interference screws for ACL repair or anchors for rotator cuff repair, is recommended in chronic cases. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Andreas Voss
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
- Sporthopaedicum, Regensburg, Straubing, Germany.
| | - Christian G Pfeifer
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Peter Angele
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
- Sporthopaedicum, Regensburg, Straubing, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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Ricchetti ET. Editorial Commentary: Are Serum Inflammatory Markers Useful Diagnostic Tools in the Shoulder? Arthroscopy 2021; 37:83-85. [PMID: 33384103 DOI: 10.1016/j.arthro.2020.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 02/02/2023]
Abstract
Serum inflammatory markers are commonly used to evaluate for the presence of surgical-site infection or periprosthetic joint infections following orthopaedic surgery. However, data on the utility of these tests following shoulder surgery are more limited. Worse diagnostic performance is seen in the shoulder when compared with use of these tests in the evaluation of hip and knee infections, likely due to the low virulence of the commonly cultured shoulder organisms, and the normalization of these serum markers following shoulder surgery is less well defined when compared with the hip and knee literature. A better understanding of the behavior of these serum inflammatory markers in the shoulder may enhance the utility of these tests in the diagnosis and management of infection following elective shoulder surgery.
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Contreras ES, Frantz TL, Bishop JY, Cvetanovich GL. Periprosthetic Infection After Reverse Shoulder Arthroplasty: a Review. Curr Rev Musculoskelet Med 2020; 13:757-768. [PMID: 32827305 PMCID: PMC7661562 DOI: 10.1007/s12178-020-09670-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW Periprosthetic infection is a relatively rare but potentially devastating complication after shoulder arthroplasty. The purpose of this article is to review the incidence, diagnosis, prevention, and management of periprosthetic infections after reverse shoulder arthroplasty, with a focus on literature published within the last 5 years. RECENT FINDINGS The 2018 International Consensus Meeting on Musculoskeletal Infection provides us with a framework for the diagnosis and management of periprosthetic infections after shoulder arthroplasty. Reverse shoulder arthroplasty has a higher reported rate of infection compared with anatomic total shoulder arthroplasty. Our current diagnostic tests do not appear to be as sensitive when compared with the hip and knee literature. Similar success has been reported with single and two-stage revision protocols, although prospective comparative data are lacking. The significance of unexpected positive cultures during revision arthroplasty remains unclear. We report current diagnostic and therapeutic options for periprosthetic infection after reverse shoulder arthroplasty. Much of the current literature does not distinguish between anatomic and reverse shoulder arthroplasty. Further high-level studies are warranted to refine these definitions and guide management.
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Affiliation(s)
- Erik S. Contreras
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Travis L. Frantz
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Julie Y. Bishop
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Gregory L. Cvetanovich
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH USA
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