Friday, December 5, 2014

Which reverse total shoulders are likely to get infected?

Risk factors for periprosthetic infection after reverse shoulder arthroplasty.

These authors reviewed 301 primary RSAs with a minimum of 1-year follow-up. Among these there were 15 periprosthetic infections. Patients having reverse shoulder for failed prior arthroplasty and patients younger than 65 years had an increased risk for development of an infection. Three patients cultured methicillin-sensitive Staphylococcus aureus, two cultured methicillin-resistant S. aureus, two cultured Probionibacterium, two coagulase negative staph and one  Enterobacter cloacae. Interestingly, five patients had no culture growth despite gross purulence noted at the time of surgery. 

Comment: A one year followup may not be long enough to capture the total number of infections after a reverse or, indeed, any type of shoulder arthroplasty as shown in this prior post. In fact 9 patients of the patients in this series developed an infection more than12 months after surgery. The number of specimens submitted for culture has been shown to be strongly related to the rate of positive cultures - this number is not specified in this report. Thus it is possible that the actual rate of infection was larger than what is presented here.


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