Authors: Joseph Mileti, M.D., John W.Sperling, M.D., Robert H. Cofield, M.D.
Title: Reimplantation of a Shoulder Arthroplasty after Previous Infected Arthroplasty
Address: Mayo Clinic, 200 First Street SW, Rochester, MN 55905
Purpose: Currently, there is little information on the results of reimplantation of shoulder arthroplasty after previous infected arthroplasty. The purpose of this study was to determine the results, the risk factors for an unsatisfactory outcome, and the rates of failure.
Methods: Between 1975 and 2000, five patients with an infected shoulder arthroplasty underwent prosthesis resection and subsequent reimplantation of a prosthesis. This group consisted of 3 women and 2 men with a mean age of 58 years. Each of the shoulders underwent resection arthroplasty, IV antibiotics for 2-8 weeks, and reimplantation of a shoulder arthroplasty. The mean clinical follow-up was 7.5 years (range, 2 to 15 years).
Results: There were no patients with recurrent infection. At the most recent follow-up, three patients had no pain, one had slight pain, and one had moderate pain. Mean elevation improved from 76 degrees to 100 degrees and external rotation improved from 17 degrees to 52 degrees. With regard to patient satisfaction, two patients rated themselves as much better, two better, and one the same. There was one excellent result, two satisfactory results, and two unsatisfactory results.
Discussion: The present protocol at our institution for an infected shoulder arthroplasty includes two stage reimplantation. This involves resection of the infected arthroplasty, placement of an antibiotic impregnated cement spacer, and organism specific IV antibiotics. Prior to reimplantation, a CBC with differential, sedimentation rate, C-reactive protein, and bone/indium scans are performed. Intraoperative pathology is sent to rule out acute inflammation and cultures are sent to microbiology. Reimplantation is delayed if the pathology demonstrates acute inflammation.
Significance: Reimplantation of a shoulder arthroplasty can be performed with a low risk of reinfection. However, arthroplasty in this setting is especially challenging due to the potential for significant bone and soft tissue deficits. These challenges can compromise the clinical results in this group of patients.
