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One-stage revision for patients with a chronically infected reverse total shoulder replacement

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Abstract
We retrospectively reviewed 11 consecutive patients with an infected reverse shoulder prosthesis. Patients were assessed clinically and radiologically, and standard laboratory tests were carried out. Peroperative samples showed Propionbacterium acnes in seven, coagulase-negative Staphylococcus in five, methicillin-resistant staphylococcus aureus in one and Escherichia coli in one. Two multibacterial and nine monobacterial infections were seen. Post-operatively, patients were treated with intravenous cefazolin for at least three days and in all antibiotic therapy was given for at least three months. Severe pain (3 of 11) or severe limitation of function (3 of 11) are not necessarily seen. A fistula was present in eight, but function was not affected. All but one patient were considered free of infection after one-stage revision at a median follow-up of 24 months, and without antibiotic treatment for a minimum of six months. One patient had a persistent infection despite a second staged revision, but is now free of infection with a spacer. Complications included posterior dislocation in one, haematoma in one and a clavicular fracture in one. At the most recent follow-up the median post-operative Constant-Murley score was 55, 6% adjusted for age, gender and dominance. A one-stage revision arthroplasty reduces the cost and duration of treatment. It is reliable in eradicating infection and good functional outcomes can be achieved.
Keywords
MANAGEMENT, SURGERY, DEBRIDEMENT, ANTIBIOTICS, COMPLICATIONS, ARTHROPLASTY, DIRECT-EXCHANGE, TOTAL HIP-REPLACEMENT, FUNCTIONAL RECOVERY

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Citation

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Chicago
Beekman, Pieter, D Katusic, BM Berghs, A Karelse, and Lieven De Wilde. 2010. “One-stage Revision for Patients with a Chronically Infected Reverse Total Shoulder Replacement.” Journal of Bone and Joint Surgery-british Volume 92B (6): 817–822.
APA
Beekman, P., Katusic, D., Berghs, B., Karelse, A., & De Wilde, L. (2010). One-stage revision for patients with a chronically infected reverse total shoulder replacement. JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 92B(6), 817–822.
Vancouver
1.
Beekman P, Katusic D, Berghs B, Karelse A, De Wilde L. One-stage revision for patients with a chronically infected reverse total shoulder replacement. JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME. 2010;92B(6):817–22.
MLA
Beekman, Pieter, D Katusic, BM Berghs, et al. “One-stage Revision for Patients with a Chronically Infected Reverse Total Shoulder Replacement.” JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME 92B.6 (2010): 817–822. Print.
@article{1045624,
  abstract     = {We retrospectively reviewed 11 consecutive patients with an infected reverse shoulder prosthesis. Patients were assessed clinically and radiologically, and standard laboratory tests were carried out. Peroperative samples showed Propionbacterium acnes in seven, coagulase-negative Staphylococcus in five, methicillin-resistant staphylococcus aureus in one and Escherichia coli in one. Two multibacterial and nine monobacterial infections were seen. Post-operatively, patients were treated with intravenous cefazolin for at least three days and in all antibiotic therapy was given for at least three months. Severe pain (3 of 11) or severe limitation of function (3 of 11) are not necessarily seen. A fistula was present in eight, but function was not affected. All but one patient were considered free of infection after one-stage revision at a median follow-up of 24 months, and without antibiotic treatment for a minimum of six months. One patient had a persistent infection despite a second staged revision, but is now free of infection with a spacer. Complications included posterior dislocation in one, haematoma in one and a clavicular fracture in one. At the most recent follow-up the median post-operative Constant-Murley score was 55, 6\% adjusted for age, gender and dominance.
A one-stage revision arthroplasty reduces the cost and duration of treatment. It is reliable in eradicating infection and good functional outcomes can be achieved.},
  author       = {Beekman, Pieter and Katusic, D and Berghs, BM and Karelse, A and De Wilde, Lieven},
  issn         = {0301-620X},
  journal      = {JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME},
  keyword      = {MANAGEMENT,SURGERY,DEBRIDEMENT,ANTIBIOTICS,COMPLICATIONS,ARTHROPLASTY,DIRECT-EXCHANGE,TOTAL HIP-REPLACEMENT,FUNCTIONAL RECOVERY},
  language     = {eng},
  number       = {6},
  pages        = {817--822},
  title        = {One-stage revision for patients with a chronically infected reverse total shoulder replacement},
  url          = {http://dx.doi.org/10.1302/0301-620X.92B6.23045},
  volume       = {92B},
  year         = {2010},
}

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