Outcomes of Shoulder Arthroplasty Performed for Postinfectious Arthritis

BACKGROUND: The purpose of this study was to evaluate the functional outcomes, infection rate, and complications associated with shoulder arthroplasty for sequelae of prior septic arthritis. METHODS: This is a retrospective cohort study of 17 patients who underwent shoulder arthroplasty for sequelae of septic arthritis. Patients were analyzed for patient-reported outcomes, complications, and reoperations. RESULTS: The 17 patients in this cohort were an average age of 65.4 ± 12.2 years old, were 58.8% male, and had an average body mass index of 27.9 ± 4.1 kg/m2. These patients underwent 14 reverse shoulder arthroplasties (RSAs; 11 after antibiotic spacer placement), one anatomic total shoulder arthroplasty after antibiotic spacer placement, and two hemiarthroplasties (both after antibiotic spacer placement). Two patients underwent reoperation (dislocated RSAs). There were four complications (23.5%): two RSA dislocations, one acromial stress fracture, and one atraumatic rotator cuff tear after hemiarthroplasty. There were no cases of postoperative wound complications or infection. At an average of 4.1 ± 1.8 years of follow-up for all 17 of 17 cases, the average visual analogue scale pain score was 4.6 ± 2.3, average Single Assessment Numeric Evaluation Score was 59.3 ± 23.7, average American Shoulder and Elbow Surgeons Score was 57.6 ± 15.5, and average Simple Shoulder Test was 6.9 ± 2.6 based on “yes” responses. CONCLUSIONS: Shoulder arthroplasty after septic arthritis had inconsistent functional outcomes and high complication rates but no reinfection.

Antibiotic Spacers in Shoulder Arthroplasty: Comparison of Stemmed and Stemless Implants

BACKGROUND: Antibiotic spacers in shoulder periprosthetic joint infection deliver antibiotics locally and provide temporary stability. The purpose of this study was to evaluate differences between stemmed and stemless spacers. METHODS: All spacers placed from 2011 to 2013 were identified. Stemless spacers were made by creating a spherical ball of cement placed in the joint space. Stemmed spacers had some portion in the humeral canal. Operative time, complications, reimplantation, reinfection, and range of motion were analyzed. RESULTS: There were 37 spacers placed: 22 were stemless and 15 were stemmed. The stemless spacer population was older (70.9 ± 7.8 years vs. 62.8 ± 8.4 years, p = 0.006). The groups had a similar percentage of each gender (stemless group, 45% male vs. stemmed group, 40% male; p = 0.742), body mass index (stemless group, 29.1 ± 6.4 kg/m² vs. stemmed group, 31.5 ± 8.3 kg/m²; p = 0.354) and Charlson Comorbidity Index (stemless group, 4.2 ± 1.2 vs. stemmed group, 4.2 ± 1.7; p = 0.958). Operative time was similar (stemless group, 127.5 ± 37.1 minutes vs. stemmed group, 130.5 ± 39.4 minutes). Two stemless group patients had self-resolving radial nerve palsies. Within the stemless group, 15 of 22 (68.2%) underwent reimplantation with 14 of 15 having forward elevation of 109°± 23°. Within the stemmed group, 12 of 15 (80.0%, p = 0.427) underwent reimplantation with 8 of 12 having forward elevation of 94°± 43° (range, 30° to 150°; p = 0.300). Two stemmed group patients had axillary nerve palsies, one of which self-resolved but the other did not. One patient sustained dislocation of reverse shoulder arthroplasty after reimplantation. One stemless group patient required an open reduction and glenosphere exchange of dislocated reverse shoulder arthroplasty at 6 weeks after reimplantation. CONCLUSIONS: Stemmed and stemless spacers had similar clinical outcomes. When analyzing all antibiotic spacers, over 70% were converted to revision arthroplasties. The results of this study do not suggest superiority of either stemmed or stemless antibiotic spacers.