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. 2019 Jun;11(3):167-181.
doi: 10.1177/1758573218779076. Epub 2018 Jul 25.

Scoping review: Diagnosis and management of periprosthetic joint infection in shoulder arthroplasty

Anthony Egglestone  1 , Helen Ingoe  1 , Jonathan Rees  2 , Michael Thomas  3 , Richard Jeavons  4 , Amar Rangan  1   5
Affiliations

Scoping review: Diagnosis and management of periprosthetic joint infection in shoulder arthroplasty

Anthony Egglestone et al. Shoulder Elbow. 2019 Jun.

Abstract

Background: The aim of this scoping review is to assess the current evidence regarding periprosthetic shoulder infection to inform development of evidence and consensus-based guidelines.

Methods: A search of Medline, Embase and PubMed was performed; two authors screened the results independently for inclusion.

Results: Totally 88 studies were included. Incidence of periprosthetic shoulder infection ranged from 0.7% to 7%. The most common organisms to cause periprosthetic shoulder infection were Propionibacterium acnes, Staphylococcus aureus, Staphylococcus epidermidis and coagulase-negative Staphylococcus. Male gender and younger age are the most reported risk factors. Erythrocyte sedimentation rate, C-reactive protein and serum/synovial biomarkers had limited diagnostic accuracy. Thirty-nine studies reported the outcome of surgical management of periprosthetic shoulder infection. Eradication rates vary from 54% to 100% for debridement procedures; 66-100% for permanent spacers; 50-100% following single-stage revision; 60-100% following two-stage revision; and 66-100% following resection arthroplasty.

Conclusion: There is wide heterogeneity in study designs and outcomes of studies are often contradictory and due to issues with methodology and small sample sizes the optimal pathways for diagnosis and management cannot be determined from this review. Future research should be based on larger cohorts and randomised trials where feasible to provide more valid research for guiding future treatment of periprosthetic shoulder infection.

Keywords: diagnosis and management; infection; periprosthetic infection; shoulder arthroplasty; shoulder replacement.

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Figures

Figure 1.
Figure 1.
Medline search strategy.
Figure 2.
Figure 2.
Embase search strategy.
Figure 3.
Figure 3.
PubMed search strategy.
Figure 4.
Figure 4.
Prisma diagram.
Figure 5.
Figure 5.
MSIS diagnostic criteria.
Figure 6.
Figure 6.
Frangiamore classification.
See this image and copyright information in PMC

References

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