Efficacy analysis of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after surgeries for proximal humeral fractures / 北京大学学报(医学版)

ABSTRACT

Objective:To evaluate the clinical results of two-stage reverse total shoulder arthroplasty for treating postoperative deep infection after surgeries for proximal humeral fractures.Methods:From January 2013 to December 2014,8 consecutive patients with postoperative deep infection after surgeries for proximal humeral fractures who were treated with two-stage reverse total shoulder arthroplasty were ret-rospectively reviewed after the final follow-up.There were 1 man and 7 women with a mean age of (58.5 ±6.4)years,of whom 3 left shoulders and 5 right shoulders were involved.There were 2 patients with periprosthetic infection after hemiarthroplasty for proximal humeral fractures,and 6 patients with hu-meral head necrosis as well as implant-associated infection after open reduction internal fixation for proxi-mal humeral fractures with the locking plate.The diagnosis of postoperative deep infection was confirmed by either the preoperative cultures or the intraoperative biopsies during the first-stage surgery.At the first-stage surgery,all the patients underwent a thorough debridement,and then an antibiotic-impregnated bone cement spacer was placed after the removal of prosthesis or locking plate.During the second-stage surgery,the cement spacer was removed,and then a revision shoulder arthroplasty with the reverse shoul-der prosthesis was performed in all the patients who were routinely followed up after the second-stage sur-gery.The visual analogue score (VAS ),Constant score and University of California Los Angeles (UCLA)score were employed to evaluate the postoperative shoulder function.Results:The mean follow-up time was (19.9 ±8.0)months (range 12 to 35 months).At the end of the follow-up,the median forward elevation [100°(60°,140°)vs.25°(0°,90°),P=0.011],the median external rotation [15°(0°,50°)vs.5°(0°,20°),P=0.048],and the median internal rotation [L4 (buttock,T12) vs.buttock (buttock,L3 ),P =0.041 ]were all significantly improved postoperatively.The median Constant score [53.5 (32,74)vs.29.0 (10,57),P=0.012],the median UCLA score [20.5 (9, 26)vs.9.5 (5,15),P=0.012],and the median VAS score [1.5 (0,5)vs.5.0 (0,8),P=0.018]were all significantly improved after the surgery.No recurrence of infection,prosthetic loosening or neurovascular injury was noted by the last follow-up.Conclusion:Two-stage reverse total shoulder arthroplasty was an effective treatment for the postoperative deep infection after surgeries for proximal humeral fractures.The shoulder function was postoperatively improved to a certain degree.