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°, abduction of 71°, and external rotation of 29°. Group II patients had a DASH score of 58, SST score of 5, forward flexion of 78°, abduction of 83°, and external rotation of 19°. 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

Keywords: Shoulder, infection, spacer, antibiotic-loaded, 2-stage, reimplantation