Saturday, April 12, 2014

Shoulder arthroplasty after septic arthritis

Shoulder arthroplasty for the treatment of postinfectious glenohumeral arthritis.

These authors reviewed 23 shoulders undergoing shoulder arthroplasty between 1977 and 2009 for postinfectious glenohumeral arthritis and followed for a minimum of 2 years (mean, 8.3 years) or until reoperation.

12 shoulders with a severe deficiency of the rotator cuff or insufficient glenoid bone stock were treated with contouring and bone grafting of the glenoid as needed, but a glenoid component was not placed. Eleven shoulders underwent glenoid replacement.

Subjectively, the result in 16 of the 23 (70%)  shoulders was rated as much better or better. Five shoulders (22%) required reoperation at a mean of 5 years. Two of these had positive cultures for at the time of revision. Three additional patients were treated for component loosening; however, intraoperative cultures remained negative without evidence of recurrent infection. 
Radiographic follow-up showed 3 glenoids and 3 humeral components were at risk for loosening. Twelve shoulders demonstrated subluxation. One shoulder developed severe anterior-superior subluxation, and 5 had moderate superior subluxation.

The authors point out that the higher-than-expected rate of clinical or radiographic loosening remains concerning for culture negative infection.

Comment: It is of note even though modern culturing methods for this organism were apparently not used,  intraoperative cultures from 2 shoulders grew Propionibacterium. One might wonder if the shoulders at risk for loosening might also have indolent infections with Propionibacterium.

It is of interest that radiographically identifiable glenoid luciences developed in 8 of the 11 TSAs (72.7%), and 3 underwent reoperation for a loose glenoid (27.2%). However, only 2 of 3 revised glenoids showed radiographic signs of loosening preoperatively so that the rate of loosening may have been greater than what was noted radiographically. Similarly, of the 23 humeral components placed, 3 (13%) underwent revision operations for loose components. However, only 2 of the 3 components had radiographic evidence of preoperative loosening. 

This article points out that arthroplasty after prior joint sepsis has a guarded prognosis due in part to the risk of persistent infection and in part to the damage done to the articular and periarticular tissues.

Consultation for those who live a distance away from Seattle.

Check out the new Shoulder Arthritis Book - click here.

Click here to see the new Rotator Cuff Book

To see the topics covered in this Blog, click here

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

See from which cities our patients come.

See the countries from which our readers come on this post.

To see other similar posts, click on the label of interest below.