Artroplastia de resección de hombro como salvamento para infecciones recalcitrantes: estado actual de la técnica a propósito de dos casos / Shoulder resection arthroplasty as a salvage procedure for recalcitrant infections: current state of the art regarding two cases

INTRODUCCIÓN Y OBJETIVOS La artroplastia de resección de hombro (ARH) se presenta como una técnica obsoleta y una opción no válida en la actualidad, debido a la evolución de las técnicas quirúrgicas y de los implantes. Pero, como consecuencia del aumento exponencial del uso de artroplastias de hombro, están aumentando en paralelo el número de fracasos e infecciones, con necesidad de revisión y rescate. Es por ello que, en determinadas situaciones y pacientes, esa técnica vuelve a ser una opción necesaria como salvataje, aunque tiene un alto coste funcional. El objetivo de nuestro trabajo, es presentar dos casos de artroplastia de resección de hombro como una opción válida de tratamiento en la actualidad y la revisión de la literatura. CASOS Se presentan dos casos de ARH como tratamiento de rescate, en un caso de osteomielitis crónica de cabeza humeral y un caso de infección de hemiartroplastia de hombro. Ambos pacientes se encontraban sin dolor y libres de infección con un seguimiento de más de 30 meses. En un caso la funcionalidad fue limitada con un Constant de 45 pero el otro caso la funcionalidad fue aceptable con un Constant de 67. CONCLUSIONES La ARH sigue siendo una técnica útil tras el fracaso de procedimientos de revisión, para resolver infecciones protésicas recalcitrantes u osteomielitis. Los resultados funcionales son pobres, por lo que debe reservarse para pacientes con baja demanda funcional y como salvataje, tras agotar otras opciones.

INTRODUCTION AND OBJECTIVES shoulder resection arthroplasty (SRA) is currently considered as an outdated technique, due to the advances in surgical techniques and new prosthesis designs. However, with the exponential increase in the use of shoulder arthroplasties, the number of failures and infections is equally increasing, as well as the revisions and salvage procedures. In certain situations, SRA is therefore a necessary solution, although it grossly compromise shoulder function. The aim of our study is to present two cases who underwent SRA as a valid treatment option nowadays and a literature review. CASES We present two cases of SRA as salvatage treatment. First case in a chronic humeral head osteomyelitis and second in a partial shoulder prosthesis recalcitrant infection. Both patients had complete pain relief and infection was solved with a follow-up over 30 months. In the first case, postoperative shoulder function was limited with a Constant­Murley score of 45. In the second case, function was fairly good with a Constant of 67. CONCLUSIONS SRA remains a valuable technique after the failure of revision procedures, as a salvage for recalcitrant prosthetic infections or osteomyelitis. The functional results are poor, so it should be reserved for patients with low functional demand and as salvatage procedure, after assess other options.

Surgical Treatment of malignant and Benign Aggressive Tumors in the Shoulder Region / 대한정형외과학회잡지

The modality of treatment for malignant or benign aggressive tumors in the shoulder includes radical or wide removal of the lesion, accompanied by chemotherapy or radiotherapy. With the introduction of chemotherapy, advance in surgical techniques, and improvements in radiographic imaging studies, the shoulder resection with reconstruction or replantation is a limb-sparing surgical option to be considered for bony and soft-tissue tumors in and around the shoulder, but amputation is used still if inevitable. We treated 16 tumors in or around the shoulder from June 1986 to August 1991: thirteen shoulder resections, two shoulder disarticulations, and one forequarter nine patients, reconstructed with a free fibular graft in two or with a allograft and myocutaneous flap in two. Chemotherapy or radiotherapy were followed if indicated. Function of the hand after the operations should be nearly normal. Mean rating for functional results was 69% (range 43-97%) by criteria of Enneking et al. During the follow-up of the mean 4 years and 1 month, a distant metastasis occurred in one case, leading to death and a local recurrence was noted in another one, indicating the forequarter amputation. Our experience indicates that shoulder resection with reconstruction or replantation can to be used for limb salvage in selected patient with tumors in or around the shoulder.