gms | German Medical Science

Objectives: Two-stage exchange arthroplasty remains the standard method for treating patients with chronic periprosthetic joint infection (PJI) with very high success rates reported in the literature. However, it is not known whether and how success should take into account patients who never underwent reimplantation after explantation at the first stage. The aim of this study was to investigate the clinical course of patients with shoulder PJI after the first stage.

Methods: All patients who underwent the first stage of a planned two-stage exchange arthroplasty for the treatment of shoulder PJI between 2007-2017 were included in this study. A review of the patients' medical files was performed to extract the relevant information for the objective of this study. Failure of treatment was assessed according to a definition determined by a Delphi-based consensus.

Results and conclusion: A total of 33 shoulders in 32 patients (16f, 16m; mean (±SD) age: 70.3 (±10.0) years) were included in this study. Reimplantation was performed in 22 of 33 cases (67%). Of these 22 cases, 20 (91%) had a successful treatment result after a mean (±SD) follow-up of 3.9 (±2.5) years. Four of 32 patients (13%) needed revision surgery in the inter-stage interval. Two failures underwent repeated explantation. Eight of the 12 cases, which did not undergo reimplantation had a resection arthroplasty and 4 retained a cement spacer. The mortality rate was 19% with all deaths occurring in patients without reimplantation.

The common belief that a two-stage exchange has a high success rate needs to be questioned. A considerable subset of patients does not undergo subsequent reimplantation after explantation for a variety of reasons. Hence, the current focus on only reporting the results of patients who underwent reimplantation may overestimate the rate of infection eradication.