Leuven University Hospital Pellenberg

Leuven, Belgium

Leuven University Hospital Pellenberg

Leuven, Belgium

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Ghijselings S.,Leuven University Hospital Pellenberg | Stuyck J.,Leuven University Hospital Pellenberg | Debeer Prof. P.,Leuven University Hospital Pellenberg
Acta Orthopaedica Belgica | Year: 2013

There is no consensus regarding treatment of periprosthetic shoulder infections. We retrospectively reviewed 17 patients diagnosed with a periprosthetic shoulder infection. Patient demographics, preoperative diagnostics, therapeutic management and functional outcome were evaluated. The Constant-Murley score (CMS), Simple Shoulder Test (SST), Visual Analogue Score (VAS) and Disabilities of the Arm, Shoulder and Hand score (DASH) were used to assess clinical outcome. Pre-and intraoperative culture results and laboratory data, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), were analyzed. Three patients were treated by two-stage revision arthroplasty, 5 by resection arthroplasty with implantation of a cement spacer, 8 by resection arthroplasty without spacer and one patient underwent polyethylene exchange and serial debridement. The mean follow-up was 4.7 years (range : 1-9.3). The CMS was 27.8 for the resection arthroplasty group, 22.7 for the two-stage revision group and 20.6 for the resection arthroplasty with spacer group. No patients received chronic antibiotic suppression. Mean CRP value was 3.7mg/L (range : 0.2 -11.1). Infection was monobacterial in 8 patients and polymicrobial in 9. The most common organisms were Coagulase negative staphylococcus (CNS) (13/17) and Propionibacterium spp. (7/17). Complications included two humeral fractures. At a mean follow-up of 4.7 years, all but one patient were considered free of infection. Worst functional results were seen with the implantation of a definitive cement spacer. Two-stage revision arthroplasty remains the gold standard in chronic infections, but is associated with a high complication rate. One-stage revision to a reverse shoulder arthroplasty (RSA) is an attractive alternative in selected cases. A surgical treatment algorithm for infected shoulder arthroplasty is proposed. © 2013, Acta Orthopædica Belgica.


Verhelst L.,Leuven University Hospital Pellenberg | Stuyck J.,Leuven University Hospital Pellenberg | Bellemans J.,Leuven University Hospital Pellenberg | Debeer P.,Leuven University Hospital Pellenberg
Journal of Shoulder and Elbow Surgery | Year: 2011

Hypothesis: Resection arthroplasty can be performed for recalcitrant shoulder infection. It is unclear whether a spacer has any benefit. We hypothesized that spacers would increase infection control and improve clinical results. Materials and methods: Twenty-one patients were evaluated retrospectively at a mean follow-up of 46.4 months: 11 patients did not receive a spacer (group A), and 10 patients did receive a spacer (group B). Patients were assessed clinically and with radiographs. Patients were scored using the Visual Analog Scale (VAS), Constant-Murley Score (CMS), Simple Shoulder Test, and Disabilities of Arm, Shoulder and Hand. Results: Infection was eradicated in 19 patients without additional surgery. Two patients had elevated C-reactive protein and erythrocyte sedimentation rate and were considered to have low-grade infections. Neither patient received a spacer and had not been revised. Infectious control was not significantly different between group A and group B (P = .48). Fourteen patients found the result good or acceptable. The VAS decreased from 6.5 to 2.6. The CMS increased significantly from 17.8 to 40.4. Active abduction averaged 78.1° and active flexion averaged 85.5°. External rotation was 21.0°. Discussion: No significant difference was shown between group A and group B. Preservation of the tuberosities was identified as a prognosticator for a good result. Unacceptable pain resulted in 5 patients with a spacer undergoing delayed reimplantation of a prosthesis. Conclusion: Resection arthroplasty can be offered to patients with long-standing deep shoulder infection that was unresponsive to previous surgical treatment. Control of infection did not differ significantly between the groups. No improvement in outcome was demonstrated with the use of cement spacers. © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.


PubMed | Leuven University Hospital Pellenberg
Type: Journal Article | Journal: Acta orthopaedica Belgica | Year: 2014

There is no consensus regarding treatment of periprosthetic shoulder infections. We retrospectively reviewed 17 patients diagnosed with a periprosthetic shoulder infection. Patient demographics, preoperative diagnostics, therapeutic management and functional outcome were evaluated. The Constant-Murley score (CMS), Simple Shoulder Test (SST), Visual Analogue Score (VAS) and Disabilities of the Arm, Shoulder and Hand score (DASH) were used to assess clinical outcome. Pre-and intraoperative culture results and laboratory data, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), were analyzed. Three patients were treated by two-stage revision arthroplasty, 5 by resection arthroplasty with implantation of a cement spacer, 8 by resection arthroplasty without spacer and one patient underwent polyethylene exchange and serial debridement. The mean follow-up was 4.7 years (range : 1-93). The CMS was 27.8 for the resection arthroplasty group, 22.7 for the two-stage revision group and 20.6 for the resection arthroplasty with spacer group. No patients received chronic antibiotic suppression. Mean CRP value was 3.7 mg/L (range: 0.2 -11.1). Infection was monobacterial in 8 patients and polymicrobial in 9. The most common organisms were Coagulase negative staphylococcus (CNS) (13/17) and Propionibacterium spp. (7/17). Complications included two humeral fractures. At a mean follow-up of 4.7 years, all but one patient were considered free of infection. Worst functional results were seen with the implantation of a definitive cement spacer. Two-stage revision arthroplasty remains the gold standard in chronic infections, but is associated with a high complication rate. One-stage revision to a reverse shoulder arthroplasty (RSA) is an attractive alternative in selected cases. A surgical treatment algorithm for infected shoulder arthroplasty is proposed.

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