Infection control and outcome of staged reverse shoulder arthroplasty for the management of shoulder infections

Abstract Introduction The treatment of septic arthritis, caused either by hematogenous seeding, injections or surgery, can be challenging. Staged reverse shoulder arthroplasty (RSA) with temporary implantation of an antibiotic loaded spacer is widely accepted, but still discussed controversially. This study investigates the shoulder specific bacterial spectrum, the infection control rate, functional outcome and infection free survival after staged RSA in the mid- to long-term follow-up. It was hypothesized that staged RSA shows high infection free survival. Methods 39 patients treated with staged reverse shoulder arthroplasty for primary septic arthritis (n=8), secondary infection (n=8) and periprosthetic infection (n=23) were retrospectively included. Infection control rate was calculated based on cultures taken intraoperatively at spacer removal and RSA implantation. Infection free survival was defined as no revision due to infection. The minimum follow-up for functional outcome was 2 years (n=14; mean 76 months; 31 – 128 months). Results Cutibacterium (26%) and coagulase negative staphylococci (23%) were the predominant pathogens. Infection control rate was 90%. Cumulative infection free survival was 91% after 128 months. Follow-up examinations showed a mean Constant Score of 48 (7 – 85), a mean QuickDASH of 40.0 (11.4 – 93.3) and a mean pain score of 1.6 (0 – 7). Conclusion Staged RSA implantation confirms to be a reliable treatment option for primary, secondary and periprosthetic infections of the shoulder. Infection control and infection free survival are satisfying. However, patients and surgeons must be aware about functional impairment even after successful treatment of infection. Level of evidence Level IV; Case Series; Treatment Study;