Luengo-Alonso G, Jiménez-Díaz V, Zorrilla-Sánchez De Neyra J, Muñoz-Sánchez G, Cecilia-López D, Jara-Sánchez F, Porras-Moreno MA

Language: Spanish
References: 9
Page: 36-40
PDF size: 250.09 Kb.

ABSTRACT

Background: Infection and instability are the complications of prosthetic shoulder surgery of more difficult management. Instability builds up to half of the cases, while the fungal infection accounts for less than 1% of all and can cause severe damage to bone and soft tissue. Methods: In this case clinical fungal infection by Candida parapsilosis is presented in a shoulder hemiarthroplasty indicated by a fracture of the proximal humerus. He received surgical treatment in two-stages and administration of fluconazole for eight weeks prior to the second surgical time. In revision surgery was placed a reverse prosthesis as definitive treatment; however, the patient suffered several episodes of dislocation in the postoperative period; a second revision prosthetic surgery was necessary to use more stable components. During this surgery, we extracted samples that were analyzed, obtaining negative results for infection. Results: Now after three years of follow-up, the patient is well, no limitations in their daily work and has a Constant Score of 50.5. Discussion: We report our experience in this exceptional situation. We know, this is one of the first cases where the fungal infection and dislocation prosthetics in the same patient meet. This situation is a challenge for the surgeon, which has to treat complications two practically at the same time; we do not have scientific evidence to establish a criterion unified for the treatment of complications after surgery for revision of arthroplasty of the shoulder, especially in reverse or mega-denture prosthesis.

REFERENCES

1. Cheung E, Willis M, Walker M, Clark R, Frankle MA: Complications in reverse total shoulder arthroplasty. J Am Acad Orthop Surg. 2011; 19(7): 439-49.

2. Clark JC, Ritchie J, Song FS, Kissenberth MJ, Tolan SJ, Hart ND, et al: Complication rates, dislocation, pain, and postoperative range of motion after reverse shoulder arthroplasty in patients with and without repair of the subscapularis. J Shoulder Elbow Surg. 2012; 21(1): 36-41.

3. Saltzman MD, Marecek GS, Edwards SL, Kalainov DM: Infection after shoulder surgery. J Am Acad Orthop Surg. 2011; 19(4): 208-18.

4. Coste JS, Reig S, Trojani C, Berg M, Walch G, Boileau P: The management of infection in arthroplasty of the shoulder. J Bone Joint Surg Br. 2004; 86(1): 65-9.

5. Springer J, Chatterjee S: Candida albicans prosthetic shoulder joint infection in a patient with rheumatoid arthritis on multidrug therapy. J Clin Rheumatol. 2012; 18(1): 52-3.

6. Lim EV, Stern PJ: Candida infection after implant arthroplasty. A case report. J Bone Joint Surg Am. 1986; 68(1): 143-5.

7. Chalmers PN, Rahman Z, Romeo AA, Nicholson GP: Early dislocation after reverse total shoulder arthroplasty. J Shoulder Elbow Surg. 2014; 23(5): 737-44.

8. Lichtman EA: Candida infection of a prosthetic shoulder joint. Skeletal Radiol. 1983; 10(3): 176-7.

9. Boileau P, Melis B, Duperron D, Moineau G, Rumian AP, Han Y: Revision surgery of reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2013; 22(10): 1359-70.