Outcomes of revision arthroplasty for shoulder periprosthetic joint infection: a three-stage revision protocol

Background: This study evaluated outcomes after treatment of shoulder periprosthetic joint infection (PJI) with a 3-stage revision protocol consisting of (1) debridement, explantation, and cement spacer placement, followed by parenteral antibiotics; (2) open biopsy and debridement; and (3) reimplantation if cultures were negative. We hypothesized this protocol would eradicate persistent infection while producing excellent functional and subjective outcomes, and there would be no difference in these parameters for patients with shoulder PJI compared with patients with revision for aseptic indications. Methods: We retrospectively analyzed a prospectively collected revision shoulder arthroplasty cohort to identify shoulder PJI patients treated with a 3-stage protocol. Demographics, culture data, range of motion, and patient-reported outcomes were collected. Outcomes for patients with shoulder PJI and revision to RTSA were compared with patients revised to RTSA for noninfectious indications. Significance was defined as P < .05. Results: There were 28 cases of shoulder PJI in 27 patients (age, 66.4 +/- 11.2 years,); of these, 21 shoulders were revised to RTSA, and 7 shoulders were revised to hemiarthroplasty. There was no recurrent infection at a mean 32-month follow-up. One year after surgery, mean forward flexion was 110 degrees +/- 41 degrees and abduction was 106 degrees +/- 42 degrees. Mean final American Shoulder and Elbow Surgeons subjective score was 66.5 +/- 23.3. The 21 shoulders with PJI revised to RTSA had no differences for functional and subjective outcomes compared with revised patients without shoulder PJI. Conclusions: A 3-stage revision protocol for shoulder PJI reliably eradicated infection. Patients with PJI revised to RTSA can have similar outcomes as patients with noninfectious revision to RTSA. (C) 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.