Management of chronic shoulder infections utilizing a fixed Articulating antibiotic-loaded spacer

Background: Literature on management of chronic shoulder infections is limited. The purpose of this study was to examine the efficacy of a standardized protocol for the management of chronic shoulder infections, including periprosthetic infections, utilizing an articulating antibiotic-loaded spacer. Material and methods: Thirty patients with chronic shoulder infections (4 primary and 26 postoperative) were treated with aggressive debridement, implantation of an antibiotic-loaded articulating spacer, and systemic antibiotics. Twenty-seven patients (90%) were compromised hosts. Eighteen patients (group I) elected to keep the spacer but three patients later underwent reimplantation, thus fifteen patients (group IA) were using the spacer as a prosthesis at their latest follow-up of 2.4 years. Twelve patients (group II, follow-up of 2.3 years) underwent reimplantation of a prosthesis. Results: Eradication of infection was accomplished in all 30 patients. Group IA patients had a Disability of Arm Shoulder and Hand (DASH) score of 50, Simple Shoulder Test (SST) score of 5, forward flexion of 73 degrees, abduction of 71 degrees, and external rotation of 29 degrees. Group II patients had a DASH score of 58, SST score of 5, forward flexion of 78 degrees, abduction of 83 degrees, and external rotation of 19 degrees. The differences between these 2 groups were not significant. Discussion: Chronic shoulder infections can be successfully treated with a protocol of aggressive debridement, antibiotic-loaded articulating spacer, and systemic antibiotics. Prolonged implantation of an articulating spacer may be a viable option in select low-demand patients with comorbidities. Level of evidence: Level IV; Retrospective Case Series, Treatment Study. (C) 2010 Journal of Shoulder and Elbow Surgery Board of Trustees.