Sunday, November 18, 2012

Periprosthetic infections after total shoulder arthroplasty: a 33-year perspective. JSES

Periprosthetic infections after total shoulder arthroplasty: a 33-year perspective. JSES

This is a retrospective review of 2207 patients having primary total shoulder arthroplasty. Periprosthetic infection was defined by one or more of the following (1) positive culture of joint fluid, (2) positive synovial/bone tissue culture, (3) purulent or thick serosanguinous joint fluid, (4) necrotic synovial tissue or (5) positive blood culture.  Apparently prosthetic explants were not cultured in this series and apparently special efforts were not used to try to recover Propionibacterium from the shoulders (note that this organism may be present in the absence of the traditional evidences of infection). 

Using their definitions, the authors found 32 confirmed deep perioprosthetic infections. Many of these appear to have been diagnosed years after the index procedure. Risk factors were male gender and young age. No other correlates were identified. 

The most common organisms were Staph species (31%) and Priopionibacterium (19%). The authors observed that the rate of diagnosis of  Priopionibacterium  infections was greater in more recent years, noting that this may be due either to a change in bacteriology of failed arthroplasties or an increased awareness of the need to use more sensitive culture strategies. 

We find that trying to define a periprosthetic infection of the shoulder is difficult, recognizing the increasing documentation of Propionibacterium cultured from shoulders revised for stiffness, pain or component loosening that appears to be 'aseptic'.  Future studies in which sensitive culture methods are used will enable us to correlate the presence of this organism with clinical findings.

We invite the interested reader to use the "Topics" function to find our eight posts on Propionibacterium.  In case you are wondering why we don't refer to this organism as P. Acnes, the answer may be found here.

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