Two-stage revision of infected shoulder arthroplasty using prosthesis of antibiotic-loaded acrylic cement: minimum three-year follow-up. 2018

Sung Hyun Lee, and Se Jin Kim, and Seng Hwan Kook, and Jeong Woo Kim
Department of Orthopedic Surgery, School of Medicine, Wonkwang University Hospital, 895 Muwang-ro, Iksan, Republic of Korea.

This study aimed to evaluate the clinical outcomes and persistent infection rate of two-stage revision of infected shoulder arthroplasty. We enrolled 12 patients who developed an infection after undergoing shoulder arthroplasty between January 2009 and January 2014. They underwent a two-stage revision with PROSTALAC implantation and shoulder re-implantation in the first- and second-stage surgery, respectively. The mean follow-up period was 40.88 months (range, 36-52 months). After the second-stage re-implantation, clinical scores, erythrocyte sedimentation rate, as well as C-reactive protein level were evaluated, and the presence of re-infection and complications were analyzed. Infection was improved in all the cases after PROSTALAC insertion. The mean range of motion of forward elevation, external rotation, and internal rotation at the final follow-up after the second-stage re-implantation were 81.67°, 40.42°, and 16.67° (vertebral level), respectively. The mean visual analog scale score improved from 7.08 points before surgery to 2.33 points after surgery. The Modified American Shoulder and Elbow Surgeons score improved from 32.25 before surgery to 64.17 after surgery (P < 0.05). The Constant shoulder score also improved from 30.92 before surgery to 66.08 after surgery (P < 0.05). Infection had not recurred until the final follow-up. However, dislocation and separation of components were found in two patients who needed a structural allograft because of segmental bone defects. Using PROSTALAC in two-stage revision arthroplasty is effective for infection control and produced good clinical outcomes after second-stage shoulder re-implantation. However, cases involving segmental bone defects require additional precautions in maintaining the appropriate tension and height to prevent complications.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D011474 Prosthesis Design The plan and delineation of prostheses in general or a specific prosthesis. Design, Prosthesis,Designs, Prosthesis,Prosthesis Designs
D012086 Reoperation A repeat operation for the same condition in the same patient due to disease progression or recurrence, or as followup to failed previous surgery. Revision, Joint,Revision, Surgical,Surgery, Repeat,Surgical Revision,Repeat Surgery,Revision Surgery,Joint Revision,Revision Surgeries,Surgery, Revision
D001843 Bone Cements Adhesives used to fix prosthetic devices to bones and to cement bone to bone in difficult fractures. Synthetic resins are commonly used as cements. A mixture of monocalcium phosphate, monohydrate, alpha-tricalcium phosphate, and calcium carbonate with a sodium phosphate solution is also a useful bone paste. Bone Cement,Bone Glues,Bone Pastes,Bone Glue,Bone Paste,Cement, Bone,Cements, Bone,Glue, Bone,Glues, Bone,Paste, Bone,Pastes, Bone
D005260 Female Females
D005500 Follow-Up Studies Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease. Followup Studies,Follow Up Studies,Follow-Up Study,Followup Study,Studies, Follow-Up,Studies, Followup,Study, Follow-Up,Study, Followup
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000072227 Shoulder Prosthesis Replacement for a SHOULDER JOINT. Artificial Shoulder Joint,Humeral Head Prosthesis,Prosthetic Shoulder,Artificial Shoulder Joints,Head Prostheses, Humeral,Head Prosthesis, Humeral,Humeral Head Prostheses,Joint, Artificial Shoulder,Joints, Artificial Shoulder,Prostheses, Humeral Head,Prostheses, Shoulder,Prosthesis, Humeral Head,Prosthesis, Shoulder,Prosthetic Shoulders,Shoulder Joint, Artificial,Shoulder Joints, Artificial,Shoulder Prostheses,Shoulder, Prosthetic,Shoulders, Prosthetic
D000072228 Arthroplasty, Replacement, Shoulder Replacement of the SHOULDER JOINT. Shoulder Replacement Arthroplasty,Total Shoulder Replacement,Arthroplasties, Shoulder Replacement,Arthroplasty, Shoulder Replacement,Replacement Arthroplasties, Shoulder,Replacement Arthroplasty, Shoulder,Replacement, Total Shoulder,Replacements, Total Shoulder,Shoulder Replacement Arthroplasties,Shoulder Replacement, Total,Shoulder Replacements, Total,Total Shoulder Replacements

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