PDF herunterladen
CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2020; 61(03): 101-107
DOI: 10.1055/s-0040-1719022
Case Report | Relato de Caso

Artroplastia de resección de hombro como salvamento para infecciones recalcitrantes. Estado actual de la técnica a propósito de dos casos

Shoulder resection arthroplasty as a salvage procedure for recalcitrant infections. Current state of the art regarding two cases
Lucas Arbeloa-Gutierrez 
1   Departamento de Ortopedia y Traumatología, Hospital García-Orcoyen, Estella, España
,
Antonio Arenas-Miquelez 
2   Macquarie University Hospital, Sydney, Australia
› Institutsangaben
› Weitere Informationen
   Lizenzen und Reprints

Resumen

Introducción y Objetivos La artroplastia de resección de hombro (ARH) se presenta como una técnica obsoleta y una opción no válida en la actualidad, debido a la evolución de las técnicas quirúrgicas y de los implantes. Pero, como consecuencia del aumento exponencial del uso de artroplastias de hombro, están aumentando en paralelo el número de fracasos e infecciones, con necesidad de revisión y rescate. Es por ello que, en determinadas situaciones y pacientes, esa técnica vuelve a ser una opción necesaria como salvataje, aunque tiene un alto coste funcional. El objetivo de nuestro trabajo, es presentar dos casos de artroplastia de resección de hombro como una opción válida de tratamiento en la actualidad y la revisión de la literatura.

Casos Se presentan dos casos de ARH como tratamiento de rescate, en un caso de osteomielitis crónica de cabeza humeral y un caso de infección de hemiartroplastia de hombro. Ambos pacientes se encontraban sin dolor y libres de infección con un seguimiento de más de 30 meses. En un caso la funcionalidad fue limitada con un Constant de 45 pero el otro caso la funcionalidad fue aceptable con un Constant de 67.

Conclusiones La ARH sigue siendo una técnica útil tras el fracaso de procedimientos de revisión, para resolver infecciones protésicas recalcitrantes u osteomielitis. Los resultados funcionales son pobres, por lo que debe reservarse para pacientes con baja demanda funcional y como salvataje, tras agotar otras opciones.

Abstract

Introduction and Objectives shoulder resection arthroplasty (SRA) is currently considered as an outdated technique, due to the advances in surgical techniques and new prosthesis designs. However, with the exponential increase in the use of shoulder arthroplasties, the number of failures and infections is equally increasing, as well as the revisions and salvage procedures. In certain situations, SRA is therefore a necessary solution, although it grossly compromise shoulder function. The aim of our study is to present two cases who underwent SRA as a valid treatment option nowadays and a literature review.

Cases We present two cases of SRA as salvatage treatment. First case in a chronic humeral head osteomyelitis and second in a partial shoulder prosthesis recalcitrant infection. Both patients had complete pain relief and infection was solved with a follow-up over 30 months. In the first case, postoperative shoulder function was limited with a Constant–Murley score of 45. In the second case, function was fairly good with a Constant of 67.

Conclusions SRA remains a valuable technique after the failure of revision procedures, as a salvage for recalcitrant prosthetic infections or osteomyelitis. The functional results are poor, so it should be reserved for patients with low functional demand and as salvatage procedure, after assess other options.

Palabras clave

Artroplastia de resección de hombro - Artroplastia de hombro - Infección - Artroplastia de hombro infectada - Procedimiento de salvamento

Keywords

shoulder resection arthroplasty - shoulder arthroplasty - Infection - shoulder prosthesis infection - salvage procedure


Publikationsverlauf

Eingereicht: 04. April 2020

Angenommen: 25. August 2020

Artikel online veröffentlicht:
24. November 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Revinter Publicações Ltda
Rio de Janeiro, Brazil

 

  • Referencias

  • 1 Cofield RH. Shoulder arthrodesis and resection arthroplasty. Instr Course Lect 1985; 34: 268-277
    PubMedGoogle Scholar
  • 2 Zumstein MA, Pinedo M, Old J, Boileau P. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: a systematic review. J Shoulder Elbow Surg 2011; 20 (01) 146-157
    CrossrefPubMedGoogle Scholar
  • 3 Boileau P. Complications and revision of reverse total shoulder arthroplasty. Orthop Traumatol Surg Res 2016; 102 (1, Suppl): S33-S43
    CrossrefPubMedGoogle Scholar
  • 4 Bonnevialle N, Dauzères F, Toulemonde J, Elia F, Laffosse JM, Mansat P. Periprosthetic shoulder infection: an overview. EFORT Open Rev 2017; 2 (04) 104-109
    CrossrefPubMedGoogle Scholar
  • 5 Marcheggiani Muccioli GM, Huri G, Grassi A. , et al. Surgical treatment of infected shoulder arthroplasty. A systematic review. Int Orthop 2017; 41 (04) 823-830
    CrossrefPubMedGoogle Scholar
  • 6 Levy JC, Triplet J, Everding N. Use of a functional anbiotic spacer in treating infected shoulder arthroplasty. Orthopedics 2015; 38 (06) e512-e519
    CrossrefPubMedGoogle Scholar
  • 7 Ghijselings S, Stuyck J, Debeer P. Surgical treatment algorithm for infected shoulder arthroplasty: a retrospective analysis of 17 cases. Acta Orthop Belg 2013; 79 (06) 626-635
    PubMedGoogle Scholar
  • 8 Rispoli DM, Sperling JW, Athwal GS, Schleck CD, Cofield RH. Pain relief and functional results after resection arthroplasty of the shoulder. J Bone Joint Surg Br 2007; 89 (09) 1184-1187
    CrossrefPubMedGoogle Scholar
  • 9 Angelini A, Mavrogenis AF, Trovarelli G. , et al. Extra-articular shoulder resections: outcomes of 54 patients. J Shoulder Elbow Surg 2017; 26 (11) e337-e345
    CrossrefPubMedGoogle Scholar
  • 10 Muh SJ, Streit JJ, Lenarz CJ. , et al. Resection arthroplasty for failed shoulder arthroplasty. J Shoulder Elbow Surg 2013; 22 (02) 247-252
    CrossrefPubMedGoogle Scholar
  • 11 Gauci MO, Cavalier M, Gonzalez JF. , et al. Revision of failed shoulder arthroplasty: epidemiology, etiology, and surgical options. J Shoulder Elbow Surg 2020; 29 (03) 541-549
    CrossrefPubMedGoogle Scholar
  • 12 Wagner ER, Hevesi M, Houdek MT, Cofield RH, Sperling JW, Sanchez-Sotelo J. Can a reverse shoulder arthroplasty be used to revise a failed primary reverse shoulder arthroplasty?: Revision reverse shoulder arthroplasty for failed reverse prosthesis. Bone Joint J 2018; 100-B (11) 1493-1498
    CrossrefPubMedGoogle Scholar
  • 13 Mercurio M, Castioni D, Iannò B, Gasparini G, Galasso O. Outcomes of revision surgery after periprosthetic shoulder infection: a systematic review. J Shoulder Elbow Surg 2019; 28 (06) 1193-1203
    CrossrefPubMedGoogle Scholar
  • 14 Verhelst L, Stuyck J, Bellemans J, Debeer P. Resection arthroplasty of the shoulder as a salvage procedure for deep shoulder infection: does the use of a cement spacer improve outcome?. J Shoulder Elbow Surg 2011; 20 (08) 1224-1233
    CrossrefPubMedGoogle Scholar
  • 15 Jacquot A, Sirveaux F, Roche O, Favard L, Clavert P, Molé D. Surgical management of the infected reversed shoulder arthroplasty: a French multicenter study of reoperation in 32 patients. J Shoulder Elbow Surg 2015; 24 (11) 1713-1722
    CrossrefPubMedGoogle Scholar
  • 16 Garrigues GE, Zmistowski B, Cooper AM, Green A. ICM Shoulder Group. Proceedings from the 2018 International Consensus Meeting on Orthopedic Infections: management of periprosthetic shoulder infection. J Shoulder Elbow Surg 2019; 28 (6S): S67-S99
    CrossrefPubMedGoogle Scholar
  • 17 Romanò CL, Borens O, Monti L, Meani E, Stuyck J. What treatment for periprosthetic shoulder infection? Results from a multicentre retrospective series. Int Orthop 2012; 36 (05) 1011-1017
    CrossrefPubMedGoogle Scholar
  • 18 George DA, Volpin A, Scarponi S, Haddad FS, Romanò CL. Does exchange arthroplasty of an infected shoulder prosthesis provide better eradication rate and better functional outcome, compared to a permanent spacer or resection arthroplasty? a systematic review. BMC Musculoskelet Disord 2016; 17: 52
    CrossrefPubMedGoogle Scholar
  • 19 Goetti P, Gallusser N, Antoniadis A, Wernly D, Vauclair F, Borens O. Advanced septic arthritis of the shoulder treated by a two-stage arthroplasty. World J Orthop 2019; 10 (10) 356-363
    CrossrefPubMedGoogle Scholar
  • 20 Coste JS, Reig S, Trojani C, Berg M, Walch G, Boileau P. The management of infection in arthroplasty of the shoulder. J Bone Joint Surg Br 2004; 86 (01) 65-69
    CrossrefPubMedGoogle Scholar
  • 21 Assenmacher AT, Alentorn-Geli E, Dennison T. , et al. Two-stage reimplantation for the treatment of deep infection after shoulder arthroplasty. J Shoulder Elbow Surg 2017; 26 (11) 1978-1983
    CrossrefPubMedGoogle Scholar
  • 22 Debeer P, Plasschaert H, Stuyck J. Resection arthroplasty of the infected shoulder: a salvage procedure for the elderly patient. Acta Orthop Belg 2006; 72 (02) 126-130
    PubMedGoogle Scholar
  • 23 Braman JP, Sprague M, Bishop J, Lo IK, Lee EW, Flatow EL. The outcome of resection shoulder arthroplasty for recalcitrant shoulder infections. J Shoulder Elbow Surg 2006; 15 (05) 549-553
    CrossrefPubMedGoogle Scholar
  • 24 Sperling JW, Kozak TK, Hanssen AD, Cofield RH. Infection after shoulder arthroplasty. Clin Orthop Relat Res 2001; (382) 206-216
    CrossrefPubMedGoogle Scholar
  • 25 Ortmaier R, Resch H, Hitzl W, Mayer M, Stundner O, Tauber M. Treatment strategies for infection after reverse shoulder arthroplasty. Eur J Orthop Surg Traumatol 2014; 24 (05) 723-731
    CrossrefPubMedGoogle Scholar
  • 26 Weber P, Utzschneider S, Sadoghi P, Andress HJ, Jansson V, Müller PE. Management of the infected shoulder prosthesis: a retrospective analysis and review of the literature. Int Orthop 2011; 35 (03) 365-373
    CrossrefPubMedGoogle Scholar
  • 27 Scalise JJ, Iannotti JP. Glenohumeral arthrodesis after failed prosthetic shoulder arthroplasty. J Bone Joint Surg Am 2008; 90 (01) 70-77
    CrossrefPubMedGoogle Scholar
  • 28 Milbrink J, Wigren A. Resection arthroplasty of the shoulder. Scand J Rheumatol 1990; 19 (06) 432-436
    CrossrefPubMedGoogle Scholar