Authors: Gerhard Maale MD, and Brian Vickaryous MD
Title: Two Staged Reconstruction Of Shoulder Sepsis
Addresses: Dallas-Ft. Worth Sarcoma Group, P.A., Presbyterian Hospital Dallas, and William Beaumont Army MC/Texas Tech UHSC E1 Paso, TX
Purpose: To outline a treatment strategy and assess the outcomes of shoulder hemiarthroplasty in the setting of septic arthritis.
Methods: A consecutive series of 13 patients with septic arthritis of the shoulder treated at the Dallas Fort Worth Sarcoma Group from 1989 to 1998 was retrospectively reviewed. The average age was 66 years (range 31-80). Seven were postoperative complications, two were hematogenous in origin, and three were the result of direct extension. Four were acute, nine were chronic (greater then four weeks). Eleven were right sided, eight were female. Follow-up averaged 6.4 years (4-8.7 years). All had positive intraoperative cultures and frozen sections with >I 0 polymorphonuclear cells/HPF. Ten patients had at least one systemic comorbidity, three having three or more. All patients had local bone and soft tissue risk factors that would predispose failure. Eight monomicrobial and four polymicrobial infections were documented. Ten of 15 (66%) were virulent organisms. All patients underwent an exchange hemiarthroplasty with antibiotic impregnated cement, debridement, and antibiotic therapy. Twelve were treated as two-stage and one as single-stage exchanges. Seven patients had deltoid, split thickness and/or latissimus, and pectoral grafts for soft tissue coverage. Two patients received composite proximal humeral allografts. All patients underwent physical therapy and antibiotic therapy for six months.
Results: There were twelve successful implantations and one failure 6.6 years postoperatively. All skin grafts and composite bone allografts healed. There were five perioperative complications and eight late complications. Abduction averaged 74.5 degrees and forward flexion 86 degrees. Seven patients were very satisfied and 2 satisfied. Two patients admitted to residual pain.
Conclusion And Discussion: Delayed exchange arthroplasty for septic arthritis involving a painful shoulder is a successful method of treatment. Local flaps are successful in managing soft tissue defects. Function and pain is better than in other treatment options.