Friday, October 26, 2012

Periprosthetic infections after shoulder hemiarthroplasty. JSES

Periprosthetic infections after shoulder hemiarthroplasty published recently by JSES.

This study reviewed the 32 year experience at the Mayo clinic regarding infections after humeral hemiarthroplasty. For the 1431 primary arthroplasties followed for an average of 8 years, 21 recorded (14 confirmed)  infections were identified by medical record review. On review of the article we could not be certain whether data on the occurrence of infection were available for all of the 1431 patients.

The definition of  'deep periprosthetic infection' used in this study was the presence of one or more of the following:
(1) positive joint fluid culture
(2) clinically suspected septic arthritis (necrotic tissue, serosanguinous or purulent joint fluid) even if cultures were negative
(3) pus or purulenceat surgery
(4) positive tissue culture

A standard protocol for specimen harvest and for culturing the harvested specimens was not described.

Organisms cultured included Staph Aureus, coag-negative Staph, and P Acnes most commonly, but also included Clostridium, Pseudomonas, Bacillus, Enterococcus, and MRSA.

The only risk factor that could be associated with the occurrence of infection was a history of trauma. Early infections (<6 month) seemed more likely due to Staph aureus, intermediate term infection (6-24 months) seemed more likely due to coag-negative Staph, and late infection (>24 months) seemed more likely due to P Acnes, MRSA, or Clostridium.

There is an increasing interest in the finding that P Acnes is commonly cultured from deep specimens in shoulders revised for pain, stiffness and prosthetic loosening. The interested reader may like to review the information posted here, here, here, here, here, here, and here. As well as here, here, and here.

We're sure that there will be much more on this topic coming out soon.


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