Interpositional biologic resurfacing then infection then ream and run

A patient came to us after having had a biological inter positional arthroplasty elsewhere about a year previously. A couple of months post operatively he had pain, swelling and redness afterwards that responded to a 10 day course of antibiotics that resolved his acute symptoms. However his shoulder continued to be stiff and painful. He presented to us without symptoms of infection and the x-rays and MRI shown below.

Being suspicious of a persistent infection, we obtained cultures while performing a ream and run procedure. 

He was placed on antibiotics after surgery. Two of the three cultures of tissue removed from over his glenoid grew out Propionibacterium.  He will remain on IV antibiotics for 6 weeks followed by a year of oral antibiotics. 

One might ask (1) why did the third culture from his glenoid tissue not grow out? and (2) where did the Propionibacterium come from?

His early rehab is going well. Stay tuned.

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