Shoulder
Treatment of glenohumeral sepsis with a commercially produced antibiotic-impregnated cement spacer

https://doi.org/10.1016/j.jse.2010.01.012Get rights and content

Background

We report our experience in treating infected shoulder arthroplasty and primary shoulder sepsis using a commercially produced antibiotic-impregnated cement spacer.

Materials and methods

We treated 16 shoulders in 15 patients for infected arthroplasty or osteomyelitis of the proximal humerus with irrigation and débridement, hardware removal, or humeral head resection, or both, and placement of an interval articulating hemiarthroplasty with a commercially made gentamicin-impregnated cement spacer.

Results

Mean follow-up was 20.5 months after spacer placement. At the time of débridement, 12 shoulders had positive cultures; the most common organisms were methicillin-resistant Staphylococcus aureus (n = 3) and S. epidermidis (n = 3). Twelve patients underwent revision. Four refused revision and have retained antibiotic spacers. White blood cell counts returned to within normal ranges in all patients at the time of revision, the erythrocyte sedimentation rate in 5 of 12 patients, C-reactive protein in 8 of 12 patients, and interleukin-6 in 9 of 11 patients. Mean visual analog pain scale score decreased from 8.4 before spacer placement to 0.5 at the final follow-up. Active forward flexion increased from a mean of 65° to 110°, and active external rotation from –5° to 20°. Mean University of California Los Angeles (UCLA) Shoulder Rating Scale score increased from 7 to 26, Simple Shoulder Test (SST) from 1.2 to 6.6, American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form score from 16 to 74, and Constant score from 16 to 57. There was no recurrence of infection.

Conclusions

Treatment of glenohumeral sepsis with a commercially produced antibiotic-impregnated cement spacer appears to be an effective treatment modality, and serum interleukin-6 level appears to be useful in the evaluation of shoulder infection.

Section snippets

Materials and methods

This study was approved by the Institutional Review Board of Miami Valley Hospital, Dayton, Ohio (Protocol #09-0023).

Between 2006 and 2008, 17 shoulders in 16 patients were treated by 1 surgeon for infected arthroplasty or osteomyelitis of the proximal humerus, of which 16 shoulders were included in the present study. One patient was excluded because of reinfection of the revision total shoulder prosthesis. His prosthesis was presumed to have been seeded from a pelvic abscess that had cultures

Results

Of the 16 shoulders included in this study, 6 had an infected hemiarthroplasty, 5 had an infected total shoulder arthroplasty (3 of which were a reverse ball-and-socket prosthesis), 4 had primary osteomyelitis of the humeral head, and 1 had proximal humeral osteomyelitis with retained hardware from previous open reduction and internal fixation of a proximal humerus fracture. The group consisted of 11 right and 5 left shoulders in 12 men and 3 women, and their mean age was 58.9 years (range,

Discussion

Many modalities for treatment of deep infection of the shoulder have been reported. Although débridement and culture-specific intravenous antibiotics are almost ubiquitously advocated, various means of definitive treatment are currently used, including 1-stage and 2-stage revision arthroplasty with an articulating interval spacer.3, 4, 10, 13, 17, 22, 23, 24 Several authors have reported successful eradication of deep infection using 2-stage revision with an articulating interval

Conclusions

We treated 16 infected shoulders in 15 patients with staged revision arthroplasty with an interval, commercially produced, antibiotic-impregnated articulating cement spacer and observed no recurrence of infection. Our patients demonstrated improved pain and range of motion, as well as subjective and objective shoulder evaluation scores. A commercially produced spacer may be as effective in controlling infection as an intraoperatively crafted spacer because it allows for a more predictable level

Disclaimer

Authors Coffey and Ely, their immediate families, and any research foundations with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. Dr Crosby is a paid consultant, member of the speakers' bureau, and has received royalties from Exactech Inc, Gainesville, Florida, USA.

References (25)

  • Q. Cui et al.

    Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty

    J Bone Joint Surg Am

    (2007)
  • J.M. Curtis et al.

    Acute renal failure after placement of tobramycin-impregnated bone cement in an infected total knee arthroplasty

    Pharmacotherapy

    (2005)
  • Cited by (57)

    • One- or two-stage exchange for periprosthetic shoulder infection: Systematic review and meta-analysis

      2020, Orthopaedics and Traumatology: Surgery and Research
      Citation Excerpt :

      The main bacterium involved is Cutibacterium acnes [2–10]. Treatment strategies are inspired by those in total knee or hip prosthetic infection, and comprise: long-course suppressive antibiotic therapy [11,12], synovectomy without implant exchange [13–16], resection arthroplasty [13,17–22], arthrodesis [23], and 1- or 2-stage implant exchange [24–29]. Isolated suppressive antibiotic therapy or synovectomy show high failure rates in chronic infection.

    View all citing articles on Scopus
    View full text