A Member of Multidisciplinary Team: Total Shoulder Arthroplasty Humeral Implant Loosening in Immunocopromised Patient

  • Justs Sauka (Speaker)
  • Mārcis Radziņš (Co-author)
  • Vigante, D. (Co-author)

Activity: Talk or presentation types › Poster presentation

Description

Patients who have undergone total shoulder arthroplasty(TSA) should be monitored vigorously. International consensus meeting Philly suggests radiological findings such as non-traumatic periprosthetic fracture, fracture of arthroplasty material, osteolysis without loosening, periosteal new bone formation etc. should be considered as periprosthetic infection. 64 years old female, 30.03.2013 fell on her right shoulder sustaining right humerus proximal metaphysis fracture. She has been treated non-operatively in regional hospital for several months without bone consolidation. CT and MRI rise a suspicion of bone malignancy. 05.11.2013 open biopsy confirmed bone neoplasm-plasmacytoma. 13.11.2013 partial right humerus resection, TSA with Delta Extend prothesis. Post operative period went without complication, regained function of the arm. Haematologist started multiple myeloma treatment with chemotherapy and immunosuppression. Patient came for check-ups annually. 01.12.2020 X-ray and MRI findings displayed humerus implant loosening, free fluid collection, inflammation in the soft tissues, suspicion of recurrence of malignancy. In 2021 patient fell on her operated shoulder and a lump developed on operated site. 12.08.2022 check up in outpatient clinic. Patient complains about pain in her right shoulder and exudative fistula. Microbiological sample – methicillin sensitive S. aureus(MSSA). 29.09.2022 revision surgery-evacuation of the implant, debridement, cement spacer with vancomycin. Microbiological sample from surgical site - MSSA. Pathohistological sample - chronic low-grade active inflammation of the soft tissues, bone trabeculae with osteosclerotic changes, no signs of oncopathology. Patient continued suppressive and antibiofilm a/b therapy. 18.10.2022. cement spacer removal, right shoulder joint revision with Mutars ® EP. 22.10.2022 two days after discharge patient dislocated shoulder prothesis. In the emergency department under general anaesthesia the shoulder was reduced in closed manner. Up to this day, patient continues with physical therapy In cases of radiographic TSA implant loosening periprosthetic infection should be excluded. Immunocompromised patients should be treated by multidisciplinary team due to higher risks of complications . .. .. .
Period29 Mar 2023
Event titleRSU International Research Conference 2023: Knowledge for Use in Practice
Event typeConference
OrganiserRīga Stradiņš University
LocationRiga, LatviaShow on map
Degree of RecognitionInternational

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