Reverse Total Shoulder Arthroplasty in the Setting of Infection

Abstract

Introduction: The most common reported complications with RSA have been instability and infection, with higher rates of infection reported in RSA than anatomic shoulder replacement. This chapter focuses on the application of RSA in the setting of infection, including a review of the literature and outcomes, preferred method of treatment, and key points and pearls. Conclusions: Increased rates of infection in RSA are likely due to a larger subacromial–glenohumeral dead space, limited viable soft tissue coverage due to a lack of rotator cuff integrity, or surgeon experience. Because of the indolent nature of the common shoulder pathogen, Propionibacterium acnes, infection is difficult to identify and surgeons should maintain a high degree of suspicion, even when initial testing does not suggest infection because of the poor sensitivity of common preoperative and intraoperative tests. For the majority of chronic infections, two-stage exchange is currently the most common choice for management. Revision to RSA via a one- or two-stage exchange has shown satisfactory outcomes in regard to reinfection rates. Reimplantation requires appropriate development of all soft tissue planes and adequate soft tissue releases to optimize shoulder range-of-motion and joint stability and depending on bone loss could require bone grafting.