Clinical Outcome of Two-Stage Revision after Periprosthetic Shoulder Infection

Sebastian Klingebiel; Christoph Theil; Georg Gosheger; Kristian Nikolaus Schneider; Thomas Ackmann; Maximilian Timme; Dominik Schorn; Dennis Liem; Carolin Rickert

doi:10.3390/jcm10020218

Clinical Outcome of Two-Stage Revision after Periprosthetic Shoulder Infection

J Clin Med. 2021 Jan 9;10(2):218. doi: 10.3390/jcm10020218.

Authors

Sebastian Klingebiel¹, Christoph Theil¹, Georg Gosheger¹, Kristian Nikolaus Schneider¹, Thomas Ackmann¹, Maximilian Timme², Dominik Schorn³, Dennis Liem⁴, Carolin Rickert¹

Affiliations

¹ Department of Orthopaedics and Tumororthopaedics, University Hospital Muenster, 48149 Münster, Germany.
² Institute for Legal Medicine, University Hospital Muenster, 48149 Münster, Germany.
³ Department for Shoulder and Elbow Surgery, Paracelsus Clinic Bremen, 28329 Bremen, Germany.
⁴ Sporthopaedicum Berlin, 10627 Berlin, Germany.

Abstract

Background: Periprosthetic shoulder infections are devastating complications after shoulder arthroplasty. A potential treatment concept is a two-stage prosthesis exchange. Data are sparse in terms of clinical outcome, including infection-free survival and patient satisfaction after this procedure. In the present study, we investigated recurrence of infection, revision-free survivorship and clinical outcome following two-stage revision due to periprosthetic shoulder infection. Furthermore, reasons for poor outcome were analyzed.

Methods: Sixteen patients undergoing two-stage revision after shoulder joint infection were retrospectively identified. Recurrence of infection was analyzed by Kaplan-Meier survival curve. Clinical outcome was quantified with subjective shoulder value (SSV), "quick" Disabilities of the Arm, Shoulder and Hand (qDASH) and Rowe score. Range of motion (ROM) was measured pre- and postoperatively. Postoperative scores and ROM were compared in a subgroup analysis according to different reimplanted prosthesis types.

Results: The reinfection-free implant survival was 81% after one year and at final follow-up (FU; mean of 33.2 months). The overall revision-free survival amounted to 56% after one year and at final FU. Patients who received reverse shoulder arthroplasty (RSA) as part of reimplantation had less disability and long-term complications. This group demonstrated better subjective stability and function compared to patients revised to megaprostheses or large-head hemiarthroplasties.

Conclusions: Two-stage revision following periprosthetic joint infection of the shoulder allows appropriate infection control in the majority of patients. However, the overall complications and revision rates due to mechanical failure or reinfection are high. Reimplantation of RSA seem superior to alternative prosthesis models in terms of function and patient satisfaction. Therefore, bone-saving surgery and reconstruction of the glenoid may increase the likelihood of reimplantation of RSA and potentially improve outcome in the case of infection-related two-stage revision of the shoulder.

Keywords: PJI; prosthesis exchange; reverse shoulder arthroplasty; revision surgery; total shoulder arthroplasty.