Treatment of glenohumeral sepsis with a commercially produced antibiotic-impregnated cement spacer

• Published in: Journal of shoulder and elbow surgery Vol. 19; no. 6; pp. 868 - 873
• Main Authors: Coffey, Michael J., MD, Ely, Erin E., BA, Crosby, Lynn A., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.09.2010; Elsevier
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - administration & dosage; Antibacterial agents; antibiotic cement spacer; Antibiotics. Antiinfectious agents. Antiparasitic agents; Arthroplasty, Replacement - adverse effects; Biological and medical sciences; Bone Cements; Coated Materials, Biocompatible; Diseases of the osteoarticular system; Female; Follow-Up Studies; Glenohumeral sepsis; Humans; Male; Medical sciences; Middle Aged; Orthopedics; Pharmacology. Drug treatments; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - surgery; Retrospective Studies; Sepsis - drug therapy; Sepsis - surgery; Shoulder Joint; Staphylococcal Infections - drug therapy; Staphylococcal Infections - microbiology; Staphylococcal Infections - surgery; Staphylococcus aureus - isolation & purification; total shoulder arthroplasty; Treatment Outcome; Treatment Study; Level IV; Glenohumeral sepsis; total shoulder arthroplasty; Case Series; antibiotic cement spacer; Infection; Sepsis syndrome; Antibiotic; Treatment; Glenohumeral joint; Spacer; Shoulder; Cement; Rheumatology; Antibacterial agent
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2010.01.012

Background We report our experience in treating infected shoulder arthroplasty and primary shoulder sepsis using a commercially produced antibiotic-impregnated cement spacer. Materials and methods We treated 16 shoulders in 15 patients for infected arthroplasty or osteomyelitis of the proximal humerus with irrigation and débridement, hardware removal, or humeral head resection, or both, and placement of an interval articulating hemiarthroplasty with a commercially made gentamicin-impregnated cement spacer. Results Mean follow-up was 20.5 months after spacer placement. At the time of débridement, 12 shoulders had positive cultures; the most common organisms were methicillin-resistant Staphylococcus aureus (n = 3) and S. epidermidis (n = 3). Twelve patients underwent revision. Four refused revision and have retained antibiotic spacers. White blood cell counts returned to within normal ranges in all patients at the time of revision, the erythrocyte sedimentation rate in 5 of 12 patients, C-reactive protein in 8 of 12 patients, and interleukin-6 in 9 of 11 patients. Mean visual analog pain scale score decreased from 8.4 before spacer placement to 0.5 at the final follow-up. Active forward flexion increased from a mean of 65° to 110°, and active external rotation from –5° to 20°. Mean University of California Los Angeles (UCLA) Shoulder Rating Scale score increased from 7 to 26, Simple Shoulder Test (SST) from 1.2 to 6.6, American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form score from 16 to 74, and Constant score from 16 to 57. There was no recurrence of infection. Conclusions Treatment of glenohumeral sepsis with a commercially produced antibiotic-impregnated cement spacer appears to be an effective treatment modality, and serum interleukin-6 level appears to be useful in the evaluation of shoulder infection.