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The Journal of Bone and Joint Surgery (American) 85:609-614 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.

Scientific Article

Shoulder Arthroplasty for the Treatment of Postinfectious Glenohumeral Arthritis

Joseph Mileti, MD, John W. Sperling, MD and Robert H. Cofield, MD

Investigation performed at the Mayo Clinic, Rochester, Minnesota

Joseph Mileti, MD
John W. Sperling, MD
Robert H. Cofield, MD
Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for J.W. Sperling: sperling.john{at}mayo.edu

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (Smith and Nephew) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Currently, no studies on shoulder arthroplasty after a previous infection of the shoulder have been published, as far as we know. The purpose of this study was to evaluate the rates of reinfection and the clinical results after shoulder arthroplasty for the treatment of postinfectious glenohumeral arthritis.

Methods: Between 1975 and 2000, thirteen patients with a history of infection of the shoulder that resulted in severe glenohumeral arthritis underwent shoulder arthroplasty. One patient who had been followed for less than two years was excluded. Therefore, twelve shoulders that had been followed for a minimum of two years (mean, 9.7 years) or until the time of revision surgery were included in the study. Complications, clinical results (pain, satisfaction, and range of motion), and radiographic results were documented at the time of the latest follow-up.

Results: No patient in this study had had a known reinfection at the time of the latest follow-up. Overall pain scores improved from 4.8 to 2.5 points after implantation of a prosthesis. Eight of the twelve patients had no pain or mild or moderate pain only after vigorous activity. The mean shoulder abduction improved from 75° to 117°, and the mean external rotation improved from 13° to 36°. Subjectively, only six of the twelve patients rated the result as much better or better. The results in the eight patients who underwent a full rehabilitation program were better than those in the four patients who underwent a limited-goals rehabilitation program.

Conclusion: Shoulder arthroplasty for the treatment of the sequelae of an infected shoulder can be performed with a low risk of reinfection. While overall pain and motion can be expected to improve, unsatisfactory clinical results that are related to the destructive effects of the initial infection are not uncommon.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.



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