Treatment of Prosthetic Joint Infection and Reconstruction of a Massive Shoulder Defect after Reverse Total Shoulder Replacement

Prosthetic joint infection is a rare but serious complication of total shoulder replacement. After infection control, shoulder reconstruction is also required to repair the shoulder defect. The shoulder is a complex structure consisting of mechanical soft tissue and the joint, making reconstruction challenging. A 78-year-old female patient was diagnosed of wound necrosis and exposed prosthesis due to prosthetic joint infection after reverse total shoulder replacement. The infection was controlled with appropriate antibiotic treatment, and the necrotic tissue was removed by radical debridement. To reduce the size of the massive shoulder defect and minimize exposure of the prosthesis, negativepressure wound therapy (NPWT) was administered for 8 weeks and shoulder reconstruction was performed using a pedicled latissimus dorsi (LD) flap and split-thickness skin graft. The patient recovered without any complications, and no reinfection of the surgical site or other complications were observed during follow-up visits. This report demonstrates that antibiotic treatment, radical debridement of necrotic tissue, NPWT, and shoulder reconstruction using a pedicled LD flap can be an effective method of treatment for prosthetic joint infection with exposed prosthesis, tissue necrosis, and massive shoulder defect.

Inter and Intra-Rater Reliability of Using Computed Tomography to Assess Prosthesis Position Post Shoulder Arthroplasty

Background Computer models and cadaveric studies have demonstrated that humeral version has a significant impact on the impingement, stability, and range of motion of the prosthetic shoulder joint. Computed tomography (CT) has been used to measure native humeral version, however the reliability of using CT to measure humeral version post reverse total shoulder replacement has not yet been established. Aims To investigate the inter and intra-rater reliability of using CT to assess the post-operative humeral version following shoulder arthroplasty. Methodology Patients underwent a limited CT scan of the operative limb; positioned and protocoled by one consultant radiologist on one machine. The humeral version of the prostheses was calculated individually by two experienced, board certified consultant radiologists. They were blinded to each other’s measurements. The humeral version was calculated using the epicondylar axis. Data Overall, 20 shoulders are included; 12 females (60%), and 10 left-sided (50%). The median anteversion was 0° (range 33° retroversion–27° anteversion; IQ 6.75° retroversion–4.75° anteversion). The inter-rater reliability was 0.985 (95% CI: 0.964–0.994). The intra-rater reliability for radiologist A was 0.988 (95% CI: 0.969–0.995), and the intra-rater reliability for radiologist B was 0.976 (95% CI: 0.942–0.991). Conclusion The use of post operative CT has excellent inter and intra-rater reliability in measuring humeral version following shoulder arthroplasty. This study will facilitate future research regarding impact of the humeral version on patient outcomes.