Results of cement spacer sonication in the second stage of two-stage treatment of shoulder arthroplasty infection
- PDF / 407,626 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 39 Downloads / 136 Views
RESEARCH ARTICLE
Open Access
Results of cement spacer sonication in the second stage of two-stage treatment of shoulder arthroplasty infection Carlos Torrens1* , Fernando Santana1, Lluis Puig1, Luisa Sorli2 and Albert Alier1
Abstract Background: The objective of this study is to present the results of cement spacer sonication in the second stage of two-stage treatment of shoulder arthroplasty infection and to determine the rate of positive cultures in the second-stage surgery in shoulder arthroplasty and its meaning. Methods: Twenty-one patients (22 cement spacers) treated with two-stage surgery because of a shoulder arthroplasty infection were included. In the second stage, the cement spacer was sent for sonication and at least four tissue cultures were obtained. Epidemiological data, comorbidities, sensitivity of the microorganisms to the antibiotic loaded in the cement spacer in the first revision surgery, time elapsed since an antibiotic was last administered until second revision procedure, functional shoulder status at last follow-up, and any complication were recorded. Results: Three out of the 22 cases (13.6%) presented positive cultures at the second-stage surgery. Periprosthetic tissue culturing detected the three positive culture cases in the second stage while the cement spacer sonication detected two and missed one. Considering periprosthetic tissue culturing as the standard procedure, the cement spacer sonication showed sensitivity at 66.6%. Recurrent infection over time was considered present in 3 patients; two of them had been previously diagnosed with a positive culture at the second stage (66.6%). Conclusions: A good number of patients (13.6%) present a positive culture at the second stage of the two-stage surgical procedure for infected shoulder arthroplasty, and those patients seem to be at high risk for recurrent infection. Periprosthetic tissue cultures have a higher sensitivity to detecting a positive culture at the second stage than cement spacer sonication. Keywords: Shoulder arthroplasty, Infection, Two-stage treatment and sonication
Background Periprosthetic joint infection (PJI) still represents the most fearsome complication in shoulder arthroplasty. Despite reasonable good results having been reported with the one-stage treatment of deep infections in shoulder arthroplasty, the gold standard treatment for chronic PJI in shoulder remains the two-stage exchange using an antibiotic-loaded cement spacer between surgeries to maintain the tension of the soft tissue as well as to deliver the antibiotic [1–9].
* Correspondence: [email protected] 1 Department of Orthopedics, Hospital del Mar. Parc de Salut Mar, Passeig Marítim 25-29, 08003 Barcelona, Spain Full list of author information is available at the end of the article
Most of the knowledge of PJI management comes from hip and knee studies. Despite the intrinsic differences with the shoulder joint such as the shoulder being a limited weight-bearing joint, different organisms implicated in shoulder infections when compared to
Data Loading...
