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

BACKGROUND The usual treatment of septic shoulder arthritis consists of arthroscopic or open lavage and debridement.However,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 eradication.In 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 limited.AIM To evaluate the results of a short interval two-stage arthroplasty approach for septic arthritis with concomitant advanced degenerative changes of the shoulder joint.METHODS 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 spacer.Shoulder arthroplasty was performed in a second stage.RESULTS Mean age was 61 years(range,47-70 years).Four patients had previous surgeries ahead of the septic arthritis.All patients had a surgical debridement ahead of the index procedure.Mean 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 procedure.The shoulder arthroplasties were performed 6 to 12 wk after insertion of the antibiotic-loaded spacer.There were two hemi and three reverse shoulder arthroplasties.Infection was successfully eradicated in all patients.The clinical outcome was satisfactory with a mean DASH score and SSV of 18.4 points and 70%respectively.CONCLUSION Short interval two-stage approach for septic shoulder arthritis is an effective treatment option.It should nonetheless be reserved for selected patients with advanced disease in which lavage and debridement have failed.