Clin Orthop Surg.  2017 Dec;9(4):489-496. 10.4055/cios.2017.9.4.489.

Antibiotic Spacers in Shoulder Arthroplasty: Comparison of Stemmed and Stemless Implants

• Padegimas
• Narzikul A
• Lawrence C
• Hendy BA
• Abboud JA
• Ramsey ML
• Williams G
• Namdari S

• KMID: 2412250
• DOI: http://doi.org/10.4055/cios.2017.9.4.489

Abstract

BACKGROUND
Antibiotic spacers in shoulder periprosthetic joint infection deliver antibiotics locally and provide temporary stability. The purpose of this study was to evaluate differences between stemmed and stemless spacers.
METHODS
All spacers placed from 2011 to 2013 were identified. Stemless spacers were made by creating a spherical ball of cement placed in the joint space. Stemmed spacers had some portion in the humeral canal. Operative time, complications, reimplantation, reinfection, and range of motion were analyzed.
RESULTS
There were 37 spacers placed: 22 were stemless and 15 were stemmed. The stemless spacer population was older (70.9 ± 7.8 years vs. 62.8 ± 8.4 years, p = 0.006). The groups had a similar percentage of each gender (stemless group, 45% male vs. stemmed group, 40% male; p = 0.742), body mass index (stemless group, 29.1 ± 6.4 kg/m² vs. stemmed group, 31.5 ± 8.3 kg/m²; p = 0.354) and Charlson Comorbidity Index (stemless group, 4.2 ± 1.2 vs. stemmed group, 4.2 ± 1.7; p = 0.958). Operative time was similar (stemless group, 127.5 ± 37.1 minutes vs. stemmed group, 130.5 ± 39.4 minutes). Two stemless group patients had self-resolving radial nerve palsies. Within the stemless group, 15 of 22 (68.2%) underwent reimplantation with 14 of 15 having forward elevation of 109°± 23°. Within the stemmed group, 12 of 15 (80.0%, p = 0.427) underwent reimplantation with 8 of 12 having forward elevation of 94°± 43° (range, 30° to 150°; p = 0.300). Two stemmed group patients had axillary nerve palsies, one of which self-resolved but the other did not. One patient sustained dislocation of reverse shoulder arthroplasty after reimplantation. One stemless group patient required an open reduction and glenosphere exchange of dislocated reverse shoulder arthroplasty at 6 weeks after reimplantation.
CONCLUSIONS
Stemmed and stemless spacers had similar clinical outcomes. When analyzing all antibiotic spacers, over 70% were converted to revision arthroplasties. The results of this study do not suggest superiority of either stemmed or stemless antibiotic spacers.

Keyword

Shoulder; Arthroplasty; Replacement; Prosthesis-related infections; Arthritis infectious

MeSH Terms

Aged
Aged, 80 and over
Anti-Bacterial Agents/*administration & dosage
Arthroplasty, Replacement, Shoulder/*adverse effects
Female
Hemiarthroplasty/adverse effects
Humans
Male
Middle Aged
Operative Time
Prosthesis-Related Infections/*drug therapy/microbiology/surgery
Range of Motion, Articular
Reoperation
Retrospective Studies
Shoulder Joint/physiopathology
Shoulder Prosthesis/*adverse effects
Tobramycin/administration & dosage
Vancomycin/administration & dosage
Anti-Bacterial Agents
Vancomycin
Tobramycin

Figure

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  Fig. 1 Anteroposterior radiograph of a stemmed implant.

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  Fig. 2 Anteroposterior radiograph of a stemless implant.

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