背景:假体周围肩关节感染(PSI)仍然是反向肩关节置换术(RSA)后的毁灭性并发症。目前,与PSI管理相关的科学数据有限,最佳治疗策略和相关临床结局仍不清楚.美国传染病学会关于假体周围关节感染管理的指南主要基于髋关节和膝关节置换术后患者的数据。这项研究的目的是评估这些指南是否对RSA后的PSI患者也有效。此外,评估了手术干预的功能结局.
方法:对RSA数据库进行回顾性审查,以确定原发和修订后的感染,在2004年至2018年之间诊断。收集的数据包括年龄,性别,RSA的指示,致病病原体,手术和抗菌治疗,功能结果,和复发。
结果:确定了36例PSI患者。手术治疗细分为清创和植入物保留(DAIR)(n=6,17%);1期翻修(n=1,3%);2期翻修(n=16,44%);多阶段翻修(>2期)(n=7,19%);确定的间隔物植入(n=2,6%);和切除关节成形术(n=4,11%)。最常见的病原体是表皮葡萄球菌(n=11,31%)和痤疮杆菌(n=9,25%)。4例患者(11%)被诊断为复发,所有这些人最初都接受了DAIR方法的治疗。中位随访期为36个月(范围,24-132个月)。
结论:PSI通常是由低毒力病原体引起的,通常被诊断为延迟,在手术时导致慢性感染。我们的结果表明,用DAIR治疗慢性PSI患者的复发率很高。此外,植入物交换(即,与植入物保留相比,1-和2-阶段交换)不会损害功能结果。因此,慢性PSI患者应接受植入物置换治疗.未来的研究应进一步阐明哪种手术策略(即,1阶段vs.2阶段交换)总体结果较好。
BACKGROUND: Periprosthetic shoulder infection (PSI) remains a devastating complication after reverse shoulder arthroplasty (RSA). Currently, scientific data related to the management of PSI are limited, and the optimal strategy and related clinical outcomes remain unclear. Guidelines from the Infectious Diseases Society of America for the management of periprosthetic joint infection are mainly based on data from patients after hip and knee arthroplasty. The aim of this study was to evaluate whether these guidelines are also valid for patients with PSI after RSA. In addition, the functional outcome according to the surgical intervention was assessed.
METHODS: An RSA database was retrospectively reviewed to identify infections after primary and revision RSAs, diagnosed between 2004 and 2018. Data collected included age, sex, indication for RSA, causative pathogen, surgical and antimicrobial treatment, functional outcome, and recurrence.
RESULTS: Thirty-six patients with a PSI were identified. Surgical treatment was subdivided into débridement and implant retention (DAIR) (n = 6, 17%); 1-stage revision (n = 1, 3%); 2-stage revision (n = 16, 44%); multiple-stage revision (>2 stages) (n = 7, 19%); definitive spacer implantation (n = 2, 6%); and resection arthroplasty (n = 4, 11%). The most common causative pathogens were Staphylococcus epidermidis (n = 11, 31%) and Cutibacterium acnes (n = 9, 25%). Recurrence was diagnosed in 4 patients (11%), all of whom were initially treated with a DAIR approach. The median follow-up period was 36 months (range, 24-132 months).
CONCLUSIONS: PSI is typically caused by low-virulence pathogens, which often are diagnosed with a delay, resulting in chronic infection at the time of surgery. Our results indicate that treatment of patients with chronic PSI with DAIR has a high recurrence rate. In addition, implant exchange (ie, 1- and 2-stage exchange) does not compromise the functional result as compared with implant retention. Thus, patients with chronic PSI should be treated with implant exchange. Future research should further clarify which surgical strategy (ie, 1-stage vs. 2-stage exchange) has a better outcome overall.