• Reinhold Ortmaier, Herbert Resch, Wolfgang Hitzl, Michael Mayer, Ottokar Stundner, and Mark Tauber.
• Department of Traumatology and Sports Injuries, Paracelsus Medical University, Müllner Hauptstraße 48, 5020, Salzburg, Austria, r.ortmaier@gmail.com.
• Eur J Orthop Surg Tr. 2014 Jul 1; 24 (5): 723-31.

IntroductionInfection after reverse shoulder arthroplasty (RSA) is a disastrous complication. No clear guidelines describing specific management strategies for infection after RSA are available.MethodsWe retrospectively analyzed 20 patients treated for deep infection after RSA. Initial irrigation and debridement and exchange of the polyethylene inlay were performed in seven patients, and initial two-stage revision was performed in 12 and initial resection arthroplasty in one patient. Patient charts were reviewed for risk factors, clinical symptoms and investigations of those symptoms, pre- and postoperative X-rays, interval until revision surgery, causative bacteria, complications, final clinical outcome and patient satisfaction.ResultsThe mean overall postoperative Constant-Murley Score (CMS) was 42.6 points, the mean UCLA score was 20.8, the mean simple shoulder test (SST) was 5.5, and the mean VAS was 1.5. When comparing the CMS, UCLA score and the SST between the revision RSA group and the resection group, significant differences between the groups were found (p<0.05). Irrigation, debridement and exchange of the polyethylene inlay were successful only in two of the four patients with acute infection. The three patients with subacute infections were treated with initial irrigation and debridement and exchange of the polyethylene inlay, which were not successful.ConclusionThe relatively high patient satisfaction can be explained by the low pain level once the patient is free from infection. However, functional results are poor in most cases, and this possible outcome must be discussed with the patient in the preoperative setting.

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