Saturday, November 29, 2014

Reverse total shoulder complications, including infection.

Risk factors for periprosthetic infection after reverse shoulder arthroplasty.

These authors reviewed 301 primary reverse total shoulders with a minimum of 1-year follow-up. There were 15 periprosthetic infections (5.0%).  One developed an acute infection (< 3 months after surgery), 5 patients developed a subacute infection (between 3 and 12 months after surgery), and 9 patients developed a late or chronic infection (> 12 months after surgery). The organisms recovered included methicillin-sensitive Staphylococcus aureus (3 patients), methicillin-resistant S. aureus (2 patients), P. acnes (2 patients),  S. epidermidis (1 patient), coagulase-negative Staphylococcus (1 patient), and Enterobacter cloacae (1 patient) were cultured. Interestingly, five patients had no culture growth despite gross purulence noted at the time of surgery.

9 (15%) of the 61 patients having a reverse total shoulder for failed prior arthroplasty developed an infection.

Of equal interest are the 74 complications in 59 patients without evidence of infection.  Forty-four intraoperative complications occurred: 18 tuberosity or humeral shaft fractures that required cerclage cabling, 12 tuberosity fractures that required no cerclage cabling, 9 glenoid fractures, 4 nerve traction injuries, and 1 vascular injury. Thirty postoperative complications occurred: 25 anterior dislocations, 3 acromial stress fractures, 1 hematoma, and 1 humeral aseptic loosening.

Comment: This series again shows a high (25%) rate of complications after reverse total shoulder arthroplasty in the hands of expert surgeons.
In that infection after arthroplasty make take years to become clinically evident (as shown in this post), it is likely that the infection rate in these patients may be greater with longer than the one year minimal followup.


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