Results of Two-Stage Treatment of Periprosthetic Shoulder Infections Using Antibiotic-Loaded Preformed Cement Spacers
DOI:
https://doi.org/10.63403/re.v32i2.406Keywords:
Periprosthetic Infection, Shoulder Prosthesis, Preformed Spacers, ShoulderAbstract
Introduction: there is scant information in the literature on the outcomes of treatment of periprosthetic shoulder infections using antibiotic-loaded preformed cemented spacers.
Objective: the aim of this study was to report the clinical outcomes of a consecutive series of patients with periprosthetic shoulder infections treated with an antibiotic-loaded preformed proximal humeral preformed cement spacer.
Materials and methods: a retrospective review of ten patients who had an antibiotic-loaded proximal humeral preformed spacer implanted from January 2018 to June 2023 as part of a 2-stage treatment plan for periprosthetic shoulder infection with a minimum follow-up of two years was performed. Clinical eradication of infection was assessed. Functional scores used included the Constant score, the ASES (American Shoulder and Elbow Surgeons) score, and the SANE (Single Assessment Numeric Evaluation) score. A visual analog scale (VAS) was used to assess pain with activities of daily living. Possible complications attributed to the spacer were also monitored.
Results: the final cohort consisted of seven women and three men. The mean age of the patients was fifty-nine years (range 50-75 years). The mean follow-up time was 3.6 years (range 2.9-5.1). Infection was eradicated in all ten patients. There was a statistically significant improvement in all the scores evaluated. Constant score improved from 42 to 64 (p <0.001). The ASES score improved from 44 to 68 (p <0.001). The SANE score improved from 45 to 65 (p <0.001) and the VAS improved from 7.3 to 1.8 (p <0.001).
Conclusion: antibiotic-loaded preformed cement spacers are an effective option for the treatment of prosthetic infections of the proximal humerus. In this study, the spacers effectively resolved all the infections and patients had significant improvement in pain and functional outcomes compared to their preoperative clinical situation.
Downloads
References
Mook WR, Garrigues GE. Diagnosis and management of periprosthetic shoulder infections. J Bone Joint Surg Am. 2014 Jun 4;96(11):956-965. doi: https://www.doi.org/10.2106/JBJS.M.00402.
Portillo ME, Salvadó M, Alier A, Sorli L, Martínez S, Horcajada JP, et al. Prosthesis failure within 2 years of implantation is highly predictive of infection. Clin Orthop Relat Res. 2013 Nov;471(11):3672-3678. doi: https://www.doi.org/10.1007/s11999-013-3200-7.
Morris BJ, O’Connor DP, Torres D, Elkousy HA, Gartsman GM, Edwards TB. Risk factors for periprosthetic infection after reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2015 Feb;24(2):161-166. doi: https://www.doi.org/10.1016/j.jse.2014.05.020.
Rangan A, Falworth M, Watts AC, Scarborough M, Thomas M, Kulkarni R, et al. Investigation and management of periprosthetic joint infection in the shoulder and elbow: evidence and consensus based guidelines of the British Elbow and Shoulder Society. Shoulder Elbow. 2018 Jul;10(1 Suppl):S5-S19. doi: https://www.doi.org/10.1177/1758573218772976.
Cooper ME, Trivedi NN, Sivasundaram L, Karns MR, Voos JE, Gillespie RJ: Diagnosis and management of periprosthetic joint infection after shoulder arthroplasty. JBJS Rev. 2019 Jul;7(7):e3. doi: https://www.doi.org/10.2106/JBJS.RVW.18.00152.
Sperling JW, Galatz LM, Higgins LD, Levine WN, Ramsey ML, Dunn J: Avoidance and treatment of complications in shoulder arthroplasty. Instr Course Lect. 2009;58:459-572.
Coste JS, Reig S, Trojani C, Berg M, Walch G, Boileau P. The management of infection in arthroplasty of the shoulder. J Bone Joint Surg Br. 2004 Jan;86(1):65-69. doi: https://doi.org/10.1302/0301-620X.86B1.14089.
Sperling JW, Kozak TK, Hanssen AD, Cofield RH. Infection after shoulder arthroplasty. Clin Orthop Relat Res. 2001 Jan;(382):206-216. doi: https://www.doi.org/10.1097/00003086-200101000-00028.
Dennison T, Alentorn-Geli E, Assenmacher AT, Sperling JW, Sanchez- Sotelo J, Cofield RH: Management of acute or late hematogenous infection after shoulder arthroplasty with irrigation, debridement, and component retention. J Shoulder Elbow Surg. 2017 Jan;26(1):73-78. doi: https://www.doi.org/10.1016/j.jse.2016.05.018.
Arenas-Miquelez A, Arbeloa-Gutierrez L, Familiari F, de Pablos J. Salvage procedures of the shoulder: glenohumeral arthrodesis and resection arthroplasty. Indian J Orthop. 2020 Oct 22;55(Suppl 1):s27-s37. doi: https://www.doi.org/10.1007/s43465-020-00279-0.
Stine IA, Lee B, Zalavras CG, Hatch G III, Itamura JM. Management of chronic shoulder infections utilizing a fixed articulating antibiotic-loaded spacer. J Shoulder Elbow Surg. 2010 Jul;19(5):739-748. doi: https://www.doi.org/10.1016/j.jse.2009.10.002.
Belay ES, Danilkowicz R, Bullock G, Wall K, Garrigues GE. Single-stage versus two-stage revision for shoulder periprosthetic joint infection: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2020 Dec;29(12):2476-2486. doi: https://www.doi.org/10.1016/j.jse.2020.05.034.
Padegimas EM, Maltenfort M, Lazarus MD, Ramsey ML, Williams GR, Namdari S: Future patient demand for shoulder arthroplasty by younger patients: national projections. Clin Orthop Relat Res. 2015 Jun;473(6):1860-1867. doi: https://www.doi.org/10.1007/s11999-015-4231-z.
Lettin AW, Copeland SA, Scales JT: The Stanmore total shoulder replacement. J Bone Joint Surg Br 1982;64:47-51. doi: https://www.doi.org/10.1302/0301-620X.64B1.7068719.
Ramsey ML, Fenlin JM Jr.Use of an antibiotic-impregnated bone cement block in the revision of an infected shoulder arthroplasty. J Shoulder Elbow Surg. 1996 Nov-Dec;5(6):479-482. doi: https://www.doi.org/10.1016/s1058-2746(96)80022-x.
McFarland EG, Rojas J, Smalley J, Borade AU, Joseph J. Complications of antibiotic cement spacers used for shoulder infections. J Shoulder Elbow Surg. 2018 Nov;27(11):1996-2005. doi: https://www.doi.org/10.1016/j.jse.2018.03.031.
Coffey MJ, Ely EE, Crosby LA. Treatment of glenohumeral sepsis with a commercially produced antibiotic-impregnated cement spacer. J Shoulder Elbow Surg. 2010 Sep;19(6):868-873. doi: https://www.doi.org/10.1016/j.jse.2010.01.012.
Magnan B, Bondi M, Vecchini E, Samaila E, Maluta T, Dall’Oca C. A preformed antibiotic-loaded spacer for treatment for septic arthritis of the shoulder. Musculoskelet Surg. 2014 Jun;98(1):15-20. doi: https://www.doi.org/10.1007/s12306-013-0268-x.
Levy JC, Triplet J, Everding N. Use of a Functional Antibiotic Spacer in Treating Infected Shoulder Arthroplasty. Orthopedics. 2015 Jun;38(6):e512-519. doi: https://www.doi.org/10.3928/01477447-20150603-60.
Padegimas EM, Narzikul A, Lawrence C, Hendy BA, Abboud JA, Ramsey ML, et al. Antibiotic spacers in shoulder arthroplasty: comparison of stemmed and stemless implants. Clin Orthop Surg. 2017 Dec;9(4):489-496. doi: https://www.doi.org/10.4055/cios.2017.9.4.489.
Rondon AJ, Paziuk T, Gutman MJ, Williams GR Jr, Namdari S. Spacers for life: high mortality rate associated with definitive treatment of shoulder periprosthetic infection with permanent antibiotic spacer. J Shoulder Elbow Surg. 2021 Dec;30(12):e732-e740. doi: https://www.doi.org/10.1016/j.jse.2021.05.005.
Strickland JP, Sperling JW, Cofield RH. The results of two-stage re-implantation for infected shoulder replacement. J Bone Joint Surg Br. 2008 Apr;90(4):460-5. doi: https://www.doi.org/10.1302/0301-620X.90B4.20002.
Grubhofer F, Imam MA, Wieser K, Achermann Y, Meyer DC, Gerber C: Staged revision with antibiotic spacers for shoulder prosthetic joint infections yields high infection control. Clin Orthop Relat Res. 2018 Jan;476(1):146-152. doi: https://www.doi.org/10.1007/s11999.0000000000000049.
Weber P, Utzschneider S, Sadoghi P, Andress HJ, Jansson V, Müller PE. Management of the infected shoulder prosthesis: a retrospective analysis and review of the literature. Int Orthop. 2011 Mar;35(3):365-373. doi: https://www.doi.org/10.1007/s00264-010-1019-3.
George DA, Volpin A, Scarponi S, Haddad FS, Romano CL. Does exchange arthroplasty of an infected shoulder prosthesis provide better eradication rate and better functional outcome, compared to a permanent spacer or resection arthroplasty? a systematic review. BMC Musculoskelet Disord. 2016 Feb 1;17:52. doi: https://www.doi.org/10.1186/s12891-016-0901-6.
Luu A, Syed F, Raman G, Bhalla A, Muldoon E, Hadley S, et al. Two-stage arthroplasty for prosthetic joint infection: a systematic review of acute kidney injury, systemic toxicity and infection control. J Arthroplasty. 2013 Oct;28(9):1490-1498.e1. doi: https://www.doi.org/10.1016/j.arth.2013.02.035.
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Ezequiel E. Zaidenberg, Fernando A. Denegri
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
This work is published under a Creative Commons Attribution–NonCommercial–ShareAlike 4.0 International License (CC BY-NC-SA 4.0). The authors retain the copyright.
