Management of periprosthetic infection after reverse shoulder arthroplasty.

Abstract Background Periprosthetic shoulder infection (PSI) remains a devastating complication after reverse shoulder arthroplasty (RSA). Currently, scientific data related to the management of PSI is limited, and the optimal strategy and related clinical outcome remains unclear. Guidelines from the Infectious Diseases Society of America for the management of periprosthetic joint infection are mainly based on data from patients after hip and knee arthroplasty. The aim of this study was to evaluate whether these guidelines are also valid for patients with PSI after RSA. In addition, the functional outcome according to the surgical intervention was assessed. Methods An RSA database was retrospectively reviewed to identify infections after primary and revised RSAs, diagnosed between 2004 and 2018. Data collected included age, sex, indication for RSA, causative pathogen, surgical and antimicrobial treatment, functional outcome and recurrence. Results Thirty-six patients with a PSI were identified. Surgical treatment was subdivided into: debridement and implant retention (DAIR) (n=6; 17%); 1-stage revision (n=1; 3%); 2-stage revision (n=16; 44%); multiple stage revisions (> 2 stages) (n=7; 19%); definitive spacer (n=2; 6%) and resection arthroplasty (n=4; 11%). The most common causative pathogens were Staphylococcus epidermidis (n=11; 31%) and Cutibacterium acnes (n=9; 25%). Four patients (11%) were diagnosed with recurrence, all of them were initially treated with a DAIR approach. The median follow-up was 36 months (range 24-132 months). Conclusion PSI is typically caused by low-virulent pathogens, which often are diagnosed with a delay resulting in chronic infection at time of surgery. Our results indicate that treating patients with chronic PSI with DAIR has a high recurrence rate. In addition, implant exchange (i.e. 1- and 2-stage) does not compromise the functional result as compared to implant retention. Thus, patients with chronic PSI should be treated with implant exchange. Future research should further clarify which surgical strategy (i.e. 1 versus 2-stage exchange) has a better outcome overall.