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.

Popliteal Venous Pseudoaneurysm and Arteriovenous Fistula after Orthopedic Surgery

Arthroscopically assisted reconstruction of the anterior cruciate ligament (LCA) is generally a safe and effective procedure with a low rate of vascular complications. We report on a case of a 33-year-old woman with a combined arteriovenous fistula (AVF) and venous popliteal aneurysm that developed 6 months after arthroscopic anterior cruciate ligament reconstruction. At clinical exam the patient presented with left popliteal and calf pain, a tender pulsatile mass posterior to her left knee, popliteal bruit and a thrill at the popliteal fossa. CT scan showed an AVF arising from the left popliteal artery. An aneurysm was seen to fill at the same time as the popliteal vein. Findings at open surgical revision included AVF between the tibioperoneal trunk and the popliteal vein and a venous popliteal aneurysm at the level of the arteriovenous communication. The aneurysm and fistula were repaired. The patient had an uneventful follow up with complete recovery. We also report an endovascular treatment of a iatrogenic arterio-venous fistula.