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Advanced septic arthritis of the shoulder treated by a two-stage arthroplasty

World Journal of Orthopedics 2019年第10期10卷 356-363页

作者： 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

BACKGROUND The usual treatment of septic shoulder arthritis consists of arthroscopic or open lavage and ***,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 *** 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 *** To evaluate the results of a short interval two-stage arthroplasty approach for septic arthritis with concomitant advanced degenerative changes of the shoulder *** 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 *** arthroplasty was performed in a second *** Mean age was 61 years(range,47-70 years).Four patients had previous surgeries ahead of the septic *** patients had a surgical debridement ahead of the index *** 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 *** shoulder arthroplasties were performed 6 to 12 wk after insertion of the antibiotic-loaded *** were two hemi and three reverse shoulder *** was successfully eradicated in all *** clinical outcome was satisfactory with a mean DASH score and SSV of 18.4 points and 70%respectiv

关键词： Septic arthritis Shoulder Arthroplasty Spacer Antibiotic Enriched Infection Native joint

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