Infection After Total Shoulder Arthroplasty

Infection of shoulder arthroplasties is a relatively rare (0.5%) but potentially devastating complication. Treatment includes resection arthroplasty, debridement and prosthetic retention, immediate exchange arthroplasty, and staged-exchange arthroplasty. To date, the most reliable treatment is staged-exchange arthroplasty. Debridement and prosthetic retention can be considered with infections detected within 3 weeks of onset, well-fixed components, no signs of osteomyelitis, and if the infecting organism is not staph epidermidis. Staged-exchange arthroplasty involves complete removal of all components, and placement of an anatomic antibiotic-impregnated cement spacer. Results can still be quite good for pain relief after reimplantation. Functional outcome has been variable in the past but may be improved significantly with the use of the reverse implant.