J Shoulder Elbow Surg. 2023 Oct 13:S1058-2746(23)00732-2. doi: 10.1016/j.jse.2023.09.007. Online ahead of print.
BACKGROUND: There is still no consensus among surgeons on whether to perform a one or two-stage surgical revision in infected shoulder arthroplasties. The aim of this systematic review and meta-analysis is to rigorously synthesize published studies evaluating the clinical outcomes, recurrence of infection and other clinical complications, in order to discuss which is the best strategy for treating periprosthetic joint infection (PJI) after shoulder arthroplasty.
METHODS: Upon research using PubMed, SCOPUS and Web of Science databases, on November 2022, studies which presented one or two-stage surgical revision as a treatment for PJI after shoulder arthroplasty and assessed the reinfection rate on these patients, as well as other clinical outcomes, with a minimum follow-up of 12 months, were included. Study quality was evaluated using the MINORS score. Reinfection and complication rates were extracted and pooled estimates were calculated using the random-effect model.
RESULTS: After careful screening, 44 studies were included, 5 reporting on one-stage, 30 on two-stage revisions and 9 assessing both strategies. There were 185 shoulders reported in one-stage revision studies, and 526 shoulders in two-stage. The overall pooled random-effects reinfection rate was 6.68% (95%CI: 3.76-10.13), with low heterogeneity (I2=28%, p=0.03). One-stage revision showed a reinfection rate of 1.14% (95%CI:0.00-4.88) and two-stage revision analysis revealed a reinfection rate of 8.81% (95%CI:4.96-13.33). There were significant statistical differences between one and two-stage reinfection rates (p=0.04). The overall pooled rate for other clinical complications was 16.76% (95%CI:9.49-25.15), with high heterogeneity (I2=70%, p<0.01). One-stage revision had a complication rate of 6.11% (95%CI:1.58-12.39) and the two-stage revision complication rate was 21.26% (95%CI:11.51-32.54). This difference was statistically significant (p=0.03).
CONCLUSIONS: This is the first systematic review and meta-analysis showing significant statistical differences between one and two-stage surgical revision in infected shoulder arthroplasties. Provided the right conditions exist, one-stage revision shows better results in infection control, with lower clinical complications and possible better clinical outcomes.