Sunday, June 14, 2015

Pain after shoulder arthroscopy - is Propionibacterium the culprit?

Propionibacterium acnes infection in shoulder arthroscopy patients with postoperative pain.

These authors prospectively collected data on all shoulder arthroscopies performed  from January 1, 2009, until April 1, 2013. Patients had ChloraPrep skin preparation and IV cefazolin or clindamycin prior to surgery. At least 2 tissue cultures (of synovium, retained sutures, implants, and / or subacromial space) were taken in 68 revision shoulder arthroscopy cases performed for pain, stiffness, or weakness (without overt clinical signs of infection). In addition, 2 tissue cultures were taken from each of a cohort of 32 primary shoulder arthroscopy cases without concern for infection. Aerobic and anaerobic cultures were observed for 14 days.

20 of the revision arthroscopies (29.4%) had positive culture findings, and 16 (23.5%) were positive for P acnes (average time to positivity was 7 days, range 4-13). Three were culture positive for coagulase negative Staph and one for Achromobacter.  In the control group, 1 patient (3.2%) had P acnes growth - of note this was the only patient in the control group that had received a steroid injection into the shoulder within one year prior to the arthroscopy.

This study of arthroscopic surgery adds evidence to similar studies from the shoulder arthroplasty literature indicating the Propionibacterium are commonly associated with postoperative pain and stiffness. Furthermore, it supports the view that arthroscopic procedures can introduce Propionibacterium into the shoulder. 

The questions remain: how can introduction of Propionibacterium at surgery be prevented and how should Propionibacterium positive shoulders be treated?


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