Treatment of Deep Infection after Total Shoulder Arthroplasty with an Antibiotic-Impregnated Cement Spacer

Introduction: Deep infections of a hemishoulder or total shoulder arthroplasty are an extremely difficult condition to treat effectively. Usually, the infection is treated at the expense of the soft tissue envelope, and the patients are left with few options after they have successfully eradicated their infection. The purpose of the present article is to describe a technique for an articulating shoulder hemiarthroplasty with antibiotic-impregnated cement for treatment of deep shoulder infection after arthroplasty and to present a retrospective review of the successful treatment of deep infections involving this treatment modality. Methods: Fourteen patients (ages 60-82) with deep chronic infections of an arthroplasty of the shoulder were treated with removal of the implant, extensive debridement, placement of an antibiotic (vancomycin) impregnated into methylmethacrylate, and covering a prosthetic stem and IV antibiotics for 6 weeks. Nine patients were then converted to standard prostheses after confirmation of eradication of their infection. Three patients were satisfied with their current function and refused further surgery. Results: All patients were infection free at follow-up averaging 22 months (12-40). Significant improvements (P < 0.05) were seen for pain visual analog pain scale (9 -> 2) and American Shoulder and Elbow Society Score (18 -> 72). Overall, patients were satisfied with their pain relief and function but still had limitations in activity of daily living. Conclusions: Aggressive treatment is necessary in the treatment of deep chronic infections of a shoulder arthroplasty. We recommend using a methylmethacrylate-coated antibiotic prosthesis for the treatment of this condition. This aids in maintaining the soft tissue envelope and prevents severe scarring formation to help maintain some functionability of the shoulder once reconstruction is performed.