Contact

Transform infected shoulder

Courtesy of Mr A Yewlett and Mr V Ramsingh, Consultant Orthopaedic Surgeons, United Lincolnshire Hospitals NHS Trust, UK
    

Clinical history

69-year-old male with a history of diabetes. The patient previously had a cemented reverse shoulder replacement for cuff tear arthropathy following a traumatic massive rotator cuff tear.

2 years after the initial surgery, the patient presented with some redness and heat around the surgical scar. His GP prescribed antibiotics, but the pain was ongoing around the shoulder. Blood tests were unremarkable and x-rays unchanged. However, as his symptoms persisted he was listed for an aspiration in theatre to exclude a PJI (Prosthetic Joint Infection).

The decision was made to perform an explantation procedure and sampling of tissues for microbiology and histology as the first stage of a planned two stage procedure.

Treatment

A H48 SYNICEM shoulder spacer with gentamicin was cemented proximally to help maintain the retroversion and height, the amount of cement used was minimal and would not pose any issues with removal for a second stage. Image intensification was used to allow mapping of the optimal position for the osteotomy to exit and allow removal of the distal cement, and also to confirm position of the spacer prior to wound closure.

The dead space was packed with 10cc of STIMULAN beads mixed with antibiotic.

The patient was treated with long term IV antibiotics via a PICC line as an outpatient for 3 months.

Outcome

CT scan following cessation of antibiotics was performed to plan the second stage revision with the intention of removing the antibiotic spacer and implanting a long stem revision reverse shoulder replacement.

“The antibiotic loaded humeral spacer was a game changer as it came prepackaged and was very easy to use which saved time at the end of a complex case.”

The infection was managed and the patient is currently awaiting the second stage of a two stage revision.

Library

Listed below are 4 of the most relevant articles for this piece but there is much more to explore on our Library page.

Explore Library