Article

Total shoulder arthroplasty infections are rare, depending on the use
of antibiotic prophylaxis, the local blood supply, the axial load gradient and
the proximal location of the shoulder. The purpose of this study was to evaluate
the results of treatment for infections in total shoulder arthroplasty and septic
arthritis using a preformed antibiotic-loaded spacer.
METHODS: Seven shoulders in as many patients were treated for infected arthroplasty or
septic arthritis without previous surgery. A preformed antibiotic-loaded spacer
was always applied. Patients were evaluated at the final follow-up with the
Constant Score (CS), the Secec Elbow Score (SES), and the American Shoulder and
Elbow Society Score (ASESS). RESULTS: The mean follow-up was 40, 71 months after
spacer implant. Infection was always confirmed preoperatively by the leukocyte
and neutrophil counts in the aspirated synovial fluid, and intra-operative biopsy
and pathologic analysis. Positive bacterial cultures were found in 5 cases: 3
MRSA and 2 Staphylococcus epidermidis. The mean SES increased from 34.43 before
spacer implant to 77.29 at final follow-up, ASESS ranged from 14.86 to 21.14, and
CS from 40.28 to 79.14. CONCLUSION: A preformed antibiotic-loaded spacer is
intended to release gentamicin alone, but we can consider adding vancomycin to
increase antibiotic spectrum.
An early diagnosis and an immediate treatment can
prevent a persistent infection and severe soft-tissue damage.
The use of a
preformed antibiotic spacer allows maintaining joint function at the intermediate
stage in two-stage treatment.

Langue : ANGLAIS