Tuesday, March 3, 2015

How do revised shoulders that are culture positive for Propionibacterium differ from those that are not?

This article presents the investigation of 132 shoulders undergoing surgical revision of a prior shoulder arthroplasty, comparing the 66 that were culture positive for Propionibacterium to the 66 that did not culture out this organism.

The authors' goal was to identify preoperative and intraoperative characteristics that may alert surgeons to an increased likelihood of positive cultures. This is important because while many shoulder arthroplasties revised for pain, stiffness, or component loosening are culture positive for Propionibacterium, the results of these cultures remain unknown until days or weeks after surgery - too late to inform intraoperative surgical decisions and immediate postsurgical antibiotic treatment. 

The authors found that Propionibacterium-positive and Propionibacterium negative shoulders were similar with respect to many characteristics; however, Propionibacterium negative shoulders were revised sooner after the index procedure and were significantly more likely to be female, to have sustained a fall, to have instability, and to have rotator cuff deficiency. Propionibacterium-positive shoulders demonstrated more glenoid erosions, glenoid osteolysis, glenoid loosening, and a higher incidence of a soft tissue membrane between the humeral component and humeral endosteum. Shoulders culture positive for Propionibacterium were more likely to be culture positive for another bacteria, such as coagulase negative Staphylococcus.

A characteristic picture of Propionibacterium  infection is the onset of stiffness, pain, loosening and / or osteolysis after a 'honeymoon' of good function following a shoulder arthroplasty, especially in a male patient. Such shoulders may merit multiple deep cultures at the time of revision surgery and consideration of aggressive surgical and medical treatment.

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