Sunday, April 13, 2014

Shoulder arthroplasty infection

Diagnosis of Periprosthetic Infection After Shoulder ArthroplastyA Critical Analysis Review

These authors review some of the important concepts regarding infections around shoulder arthroplasty components. Even though the recognized incidence of this complication is relatively low there is evidence that many infections are overlooked because (1) their manifestations may be subtle, presenting only as pain, stiffness or component loosening without the classical signs of inflammation and (2) some infections, such as those with Propionibacterium, require special approaches of specimen harvest and culture methods to establish the diagnosis. In this regard periprosthetic shoulder infections often differ from those of hip and knee arthroplasty - thus the guidelines for  diagnosis and treatment of periprosthetic joint infections of the hip and knee are often not applicable to the shoulder (i.e. CBC, Sedimentation rate, C-reactive protein, joint aspiration for culture, and intraoperative frozen sections are often insensitive to the presence of Propionibacterium. 

An evidence-based approach to culturing these organisms is shown here.

Because the diagnosis of periprosthetic infection may not become evident until cultures become positive weeks after the surgical revision, antibiotic therapy for suspected infection after operative intervention should be considered to avoid delay in treatment and re-colonization of the revised arthroplasty.

Risk factors have been identified: male gender, humeral osteolysis, humeral component loosening, glenoid wear, cloudy joint fluid and the formation of a membrane between the humeral component and the humeral bone each significantly increased the chances of a positive culture for Propionibacterium

Our current management of possibly infected shoulders is described here.

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