Outcomes of revision surgery after periprosthetic shoulder infection: a systematic review

J Shoulder Elbow Surg. 2019 Jun;28(6):1193-1203. doi: 10.1016/j.jse.2019.02.014. Epub 2019 Apr 16.


Background: Periprosthetic shoulder infection (PSI) is one of the most challenging complications after shoulder arthroplasty. Different treatments have been proposed, but the best surgical procedure remains disputed in the current literature. This systematic review investigated the outcomes of revision surgery after PSI.

Methods: The PubMed and Scopus databases were used to search keywords in April 2018. Of 2157 titles, 34 studies were finally analyzed. Demographics, laboratory and microbiological data, types of implants, surgical techniques with complications and reoperations, eradication rates, and clinical and functional outcomes were reported.

Results: A total of 754 patients were identified. Cutibacterium acnes (C. acnes) was the most common microorganism found both in PSI (33%) and persistent infections (40%). Preoperatively, C-reactive protein was elevated in 70% of patients with PSI. Reverse shoulder arthroplasty had a lower prevalence of infection (P < .001). The eradication rate was 96% with 1 stage, 93% with permanent spacers, 86% with 2 stages, 85% with resection arthroplasty, and 65% with irrigation and débridement. One-stage revision was the best treatment, considering postoperative flexion and abduction, compared with resection arthroplasty, permanent spacers, and 2-stage revision. One-stage revision showed fewer postoperative complications than irrigation and débridement, resection arthroplasty, and 2-stage surgery. Two-stage surgery was the most common treatment, and the functional score demonstrated no differences between 2-stage and 1-stage procedures.

Conclusions: Our review suggests that a 1-stage procedure should be recommended to treat PSI. Two-stage revision could be reserved for select cases in which the bacterium involved is unknown.

Keywords: Cutibacterium acnes; Periprosthetic shoulder infection; one-stage; outcomes; reverse shoulder arthroplasty; shoulder revision surgery; total shoulder arthroplasty; two-stage.

Publication types

  • Systematic Review

MeSH terms

  • Arthroplasty, Replacement, Shoulder / adverse effects*
  • Arthroplasty, Replacement, Shoulder / methods
  • Debridement
  • Humans
  • Postoperative Period
  • Propionibacterium acnes
  • Prosthesis-Related Infections / microbiology
  • Prosthesis-Related Infections / surgery*
  • Range of Motion, Articular
  • Reoperation / methods*
  • Shoulder Joint / physiopathology
  • Shoulder Joint / surgery
  • Treatment Outcome