Two-stage Reimplantation for Treating Prosthetic Shoulder Infections

Background Two-stage reimplantation for prosthetic joint infection reportedly has the lowest risk for recurrent infection. Most studies to date have evaluated revision surgery for infection using an anatomic prosthetic. As compared with anatomic prostheses, reverse total shoulder arthroplasty is reported to have a higher rate of infection.

Questions/purposes We determined reinfection rates, functional improvement, types and rates of complications, and influence of rotator cuff tissue on function for two-stage reimplantation for prosthetic joint infection treated with reverse shoulder arthroplasty.

Patients and Methods We retrospectively reviewed 27 patients treated with a two-stage reimplantation for prosthetic shoulder infection using a uniform protocol for management of infection; of these, 17 had reverse shoulder arthroplasty at second-stage surgery. Types of organisms cultured, recurrence rates, complications, function, and radiographic followup were reviewed for all patients.

Results One of the 17 patients had recurrence of infection. The mean (± SD) Penn shoulder scores for patients treated with reverse shoulder arthroplasty improved from 24.9 ± 22.3 to 66.4 ± 20.8. The average motion at last followup was 123° ± 33° of forward flexion and 26° ± 8° of external rotation in patients treated with a reverse shoulder arthroplasty. The major complication rate was 35% in reverse shoulder arthroplasty, with five dislocations and one reinfection. There was no difference in final Penn score between patients with and without external rotation weakness.

Conclusions Shoulder function and pain improved in patients treated with a second-stage reimplantation of a reverse prosthesis and the reinfection rate was low.

Level of Evidence Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.