Treatment of the infected total shoulder arthroplasty with antibiotic-impregnated cement spacers

Deep infections of the shoulder, including primary shoulder sepsis and infection after shoulder arthroplasty, are rare but devastating problems. Treatment of the infected shoulder has proven to be difficult with a high rate of complications. Few reports have been able to effectively eradicate infection while preserving anatomy and function of the shoulder. The purpose of the present article is to report our experience in treating the infected shoulder arthroplasty and shoulder sepsis with the use of 2 types of antibiotic-impregnated cement spacers. We treated 30 patients (ages 45-89 years) with either primary shoulder sepsis with humeral head osteomyelitis or chronic infection of a shoulder arthroplasty with extensive debridement, removal of the implant or humeral head, placement of an antibiotic spacer, and intravenous antibiotics. Fourteen of those shoulders were treated with an intraoperatively crafted antibiotic-impregnated cement spacer, and 16 shoulders were treated with a commercially produced antibiotic-impregnated spacer. Clinical as well as laboratory data, including interleukin-6 levels, were followed postoperatively to determine the most appropriate time for reimplantation. Among the 30 infected shoulders treated, we observed no recurrence of infection, and all patients had improved pain and function, as well as subjective and objective shoulder evaluation scores. Treatment with a spacer aids in maintaining the soft-tissue envelope, prevents severe scarring, and helps maintain some function of the shoulder once reconstruction is performed. Also, serum interleukin-6 level appears to be useful in the evaluation of shoulder infection for determination of appropriate timing for revision.