Garrigues, J Shoulder Elbow Surg 2019 - Proceedings from the 2018 International Consensus Meeting on Orthopedic Infections: Management of Periprosthetic Shoulder Infection
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Proceedings from the 2018 International Consensus Meeting on Orthopedic Infections: Management of Periprosthetic Shoulder Infection
Garrigues, ICM Shoulder Group, et al.·J Shoulder Elbow Surg·2019·104 citations
The shoulder group of the 2018 International Consensus Meeting answered 30 questions on treating periprosthetic shoulder infection, from unexpected positive cultures to 1- vs 2‑stage exchange.
Proceedings of the July 2018 meeting in Philadelphia: each question has a recommendation, a level of evidence and the delegate vote.
Key Consensus Statements
For suspected subacute or chronic infection, the group recommends removing even well‑fixed glenoid components at single‑stage revision (100% agreement, limited evidence). High‑risk patients may accept the higher failure rate of retention.
Pooling retrospective studies cited for subacute and chronic infection (most mixed in acute cases), treatment failed in 31.3% with debridement and component retention, 8.2% with 1‑stage and 11.2% with 2‑stage revision.
Pooled reinfection was 5.6% after single‑stage vs 11.4% after 2‑stage exchange (p < 0.001). The group still judged the indications for each unclear, since selection bias may explain the gap (96% agreement).
After revision with unexpected positive cultures of an indolent organism, antibiotics beyond 24 hours do not appear to lower the risk of later infection (84% agreement, 12% abstained).
Evidence was judged insufficient to support or discourage debridement with implant retention for acute infection (96% agreement). In 38 shoulders from small case series of mixed acuity, it failed in 50%.
Resection arthroplasty is an acceptable salvage when a definitive implant is too risky (95% agreement). In a cited systematic review, it eradicated infection in 72 of 83 cases, with relatively poor function.
The shoulder group of the 2018 International Consensus Meeting answered 30 questions on treating periprosthetic shoulder infection, from unexpected positive cultures to 1- vs 2‑stage exchange.
Proceedings of the July 2018 meeting in Philadelphia: each question has a recommendation, a level of evidence and the delegate vote.
Key Consensus Statements
For suspected subacute or chronic infection, the group recommends removing even well‑fixed glenoid components at single‑stage revision (100% agreement, limited evidence). High‑risk patients may accept the higher failure rate of retention.
Pooling retrospective studies cited for subacute and chronic infection (most mixed in acute cases), treatment failed in 31.3% with debridement and component retention, 8.2% with 1‑stage and 11.2% with 2‑stage revision.
Pooled reinfection was 5.6% after single‑stage vs 11.4% after 2‑stage exchange (p < 0.001). The group still judged the indications for each unclear, since selection bias may explain the gap (96% agreement).
After revision with unexpected positive cultures of an indolent organism, antibiotics beyond 24 hours do not appear to lower the risk of later infection (84% agreement, 12% abstained).
Evidence was judged insufficient to support or discourage debridement with implant retention for acute infection (96% agreement). In 38 shoulders from small case series of mixed acuity, it failed in 50%.
Resection arthroplasty is an acceptable salvage when a definitive implant is too risky (95% agreement). In a cited systematic review, it eradicated infection in 72 of 83 cases, with relatively poor function.