Background Late sequelae of septic arthritis of the gle- nohumeral joint are very rare and represent a potentially devastating condition that can result in irreversible changes at the level of joint and surrounding soft tissues. Materials and methods Between January 2001 and December 2010, ten patients were treated at our institution for late sequelae of septic arthritis of the shoulder. There were eight men and two women with a mean age of 67.9 years (range 62–74 years). Eight of ten patients had previously received three or more intra-articular or suba- cromial injections. Surgical treatment consisted of open joint debridement, humeral head resection and implanta- tion of an antibiotic spacer followed by a 6–8-week course of intravenous antibiotics. Results White blood cell count, C-reactive protein and erythrocyte sedimentation rate normalized between 6 and 8 weeks postoperatively in all patients. No recurrent infection was observed in any patient. Postoperatively, the mean Constant score was 37 (range 28–46) and mean DASH score was 54 (range 40–69), demonstrating a very limited function in these patients. There was a trend R. Garofalo Shoulder Service Hospital F. Miulli, Acquaviva delle fonti, BA, Italy R. Garofalo (&) Via Padova 13, 70029 Santeramo in Colle, BA, Italy e-mail: raffaelegarofalo@gmail.com B. Flanagin Shoulder Center, Baylor University Medical Center, Dallas, TX, USA E. Cesari E. Vinci M. Conti A. Castagna Shoulder Unit, Humanitas Institute, IRCCS, Milan, Italy toward improved outcome scores in patients who under- went early surgical debridement. Five patients underwent delayed reconstruction with a reverse shoulder prosthesis, and at minimum 1-year follow-up, the mean Constant score was 56 (range 47–69) and mean DASH score was 33 (31–38). Conclusions Antibiotic spacers are able to deliver anti- biotics locally to the infected tissue while reducing the dead space and stabilizing the glenohumeral joint. An early, aggressive management of the infection is essential to maximize clinical outcomes and avoid either significant destruction or ankylosis of the shoulder joint.

Destructive septic arthritis of shoulder in adults.

Castagna A
2014

Abstract

Background Late sequelae of septic arthritis of the gle- nohumeral joint are very rare and represent a potentially devastating condition that can result in irreversible changes at the level of joint and surrounding soft tissues. Materials and methods Between January 2001 and December 2010, ten patients were treated at our institution for late sequelae of septic arthritis of the shoulder. There were eight men and two women with a mean age of 67.9 years (range 62–74 years). Eight of ten patients had previously received three or more intra-articular or suba- cromial injections. Surgical treatment consisted of open joint debridement, humeral head resection and implanta- tion of an antibiotic spacer followed by a 6–8-week course of intravenous antibiotics. Results White blood cell count, C-reactive protein and erythrocyte sedimentation rate normalized between 6 and 8 weeks postoperatively in all patients. No recurrent infection was observed in any patient. Postoperatively, the mean Constant score was 37 (range 28–46) and mean DASH score was 54 (range 40–69), demonstrating a very limited function in these patients. There was a trend R. Garofalo Shoulder Service Hospital F. Miulli, Acquaviva delle fonti, BA, Italy R. Garofalo (&) Via Padova 13, 70029 Santeramo in Colle, BA, Italy e-mail: raffaelegarofalo@gmail.com B. Flanagin Shoulder Center, Baylor University Medical Center, Dallas, TX, USA E. Cesari E. Vinci M. Conti A. Castagna Shoulder Unit, Humanitas Institute, IRCCS, Milan, Italy toward improved outcome scores in patients who under- went early surgical debridement. Five patients underwent delayed reconstruction with a reverse shoulder prosthesis, and at minimum 1-year follow-up, the mean Constant score was 56 (range 47–69) and mean DASH score was 33 (31–38). Conclusions Antibiotic spacers are able to deliver anti- biotics locally to the infected tissue while reducing the dead space and stabilizing the glenohumeral joint. An early, aggressive management of the infection is essential to maximize clinical outcomes and avoid either significant destruction or ankylosis of the shoulder joint.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11699/3433
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