Treatment of glenohumeral sepsis with a commercially produced antibiotic-impregnated cement spacer

Michael J. Coffey, Erin E. Ely, Lynn A Crosby

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Background: We report our experience in treating infected shoulder arthroplasty and primary shoulder sepsis using a commercially produced antibiotic-impregnated cement spacer. Materials and methods: We treated 16 shoulders in 15 patients for infected arthroplasty or osteomyelitis of the proximal humerus with irrigation and débridement, hardware removal, or humeral head resection, or both, and placement of an interval articulating hemiarthroplasty with a commercially made gentamicin-impregnated cement spacer. Results: Mean follow-up was 20.5 months after spacer placement. At the time of débridement, 12 shoulders had positive cultures; the most common organisms were methicillin-resistant Staphylococcus aureus (n = 3) and S. epidermidis (n = 3). Twelve patients underwent revision. Four refused revision and have retained antibiotic spacers. White blood cell counts returned to within normal ranges in all patients at the time of revision, the erythrocyte sedimentation rate in 5 of 12 patients, C-reactive protein in 8 of 12 patients, and interleukin-6 in 9 of 11 patients. Mean visual analog pain scale score decreased from 8.4 before spacer placement to 0.5 at the final follow-up. Active forward flexion increased from a mean of 65° to 110°, and active external rotation from -5° to 20° Mean University of California Los Angeles (UCLA) Shoulder Rating Scale score increased from 7 to 26, Simple Shoulder Test (SST) from 1.2 to 6.6, American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form score from 16 to 74, and Constant score from 16 to 57. There was no recurrence of infection. Conclusions: Treatment of glenohumeral sepsis with a commercially produced antibiotic-impregnated cement spacer appears to be an effective treatment modality, and serum interleukin-6 level appears to be useful in the evaluation of shoulder infection.

Original languageEnglish (US)
Pages (from-to)868-873
Number of pages6
JournalJournal of Shoulder and Elbow Surgery
Volume19
Issue number6
DOIs
StatePublished - Sep 1 2010

Fingerprint

Sepsis
Anti-Bacterial Agents
Therapeutics
Arthroplasty
Interleukin-6
Hemiarthroplasty
Humeral Head
Los Angeles
Blood Sedimentation
Humerus
Osteomyelitis
Pain Measurement
Methicillin-Resistant Staphylococcus aureus
Elbow
Infection
Gentamicins
Leukocyte Count
C-Reactive Protein
Reference Values
Recurrence

Keywords

  • Antibiotic cement spacer
  • Case Series
  • Glenohumeral sepsis
  • Level IV
  • Total shoulder arthroplasty
  • Treatment Study

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Treatment of glenohumeral sepsis with a commercially produced antibiotic-impregnated cement spacer. / Coffey, Michael J.; Ely, Erin E.; Crosby, Lynn A.

In: Journal of Shoulder and Elbow Surgery, Vol. 19, No. 6, 01.09.2010, p. 868-873.

Research output: Contribution to journalArticle

Coffey, Michael J. ; Ely, Erin E. ; Crosby, Lynn A. / Treatment of glenohumeral sepsis with a commercially produced antibiotic-impregnated cement spacer. In: Journal of Shoulder and Elbow Surgery. 2010 ; Vol. 19, No. 6. pp. 868-873.
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abstract = "Background: We report our experience in treating infected shoulder arthroplasty and primary shoulder sepsis using a commercially produced antibiotic-impregnated cement spacer. Materials and methods: We treated 16 shoulders in 15 patients for infected arthroplasty or osteomyelitis of the proximal humerus with irrigation and d{\'e}bridement, hardware removal, or humeral head resection, or both, and placement of an interval articulating hemiarthroplasty with a commercially made gentamicin-impregnated cement spacer. Results: Mean follow-up was 20.5 months after spacer placement. At the time of d{\'e}bridement, 12 shoulders had positive cultures; the most common organisms were methicillin-resistant Staphylococcus aureus (n = 3) and S. epidermidis (n = 3). Twelve patients underwent revision. Four refused revision and have retained antibiotic spacers. White blood cell counts returned to within normal ranges in all patients at the time of revision, the erythrocyte sedimentation rate in 5 of 12 patients, C-reactive protein in 8 of 12 patients, and interleukin-6 in 9 of 11 patients. Mean visual analog pain scale score decreased from 8.4 before spacer placement to 0.5 at the final follow-up. Active forward flexion increased from a mean of 65° to 110°, and active external rotation from -5° to 20° Mean University of California Los Angeles (UCLA) Shoulder Rating Scale score increased from 7 to 26, Simple Shoulder Test (SST) from 1.2 to 6.6, American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form score from 16 to 74, and Constant score from 16 to 57. There was no recurrence of infection. Conclusions: Treatment of glenohumeral sepsis with a commercially produced antibiotic-impregnated cement spacer appears to be an effective treatment modality, and serum interleukin-6 level appears to be useful in the evaluation of shoulder infection.",
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