Thursday, July 30, 2015

Shoulder arthroplasty infection - a greater risk in shoulders with prior surgery

Infection after primary anatomic versus primary reverse total shoulder arthroplasty.

These authors reviewed 814 primary total shoulder arthroplasties and found deep periprosthetic infections in 16: 6 anatomic total shoulders (aTSA)  and 10 reverse total shoulders (rTSA).

The surgical technique included the use of surgical hoods, limitation of operating room traffic, 
antibiotic prophylaxis with intravenous cefazolin (or clindamycin in cases of b-lactam allergy) at
least 30 minutes before the incision, followed by 3 additional postoperative doses. Preparation of the surgical site was with chlorhexidine.

The infections were determined by retrospective chart review. An infection was diagnosed by joint fluid culture or tissue/bone culture. Infections occurred in 7 women (44%) and in 9 men (56%).
The isolated causative organisms were Staphylococcus  spp in 7 patients (43.8%), Propionibacterium
acnes  in 7 (43.8%), Escherichia coli  in 1 (6.3%), and both Staphylococcus  spp and P acnes  in 1 (6.3%). The prior surgeries included rotator cuff repair in 5, Bankart repair in 1, ORIF for fracture in 1, and arthroscopic debridement/biceps tenotomy in 1. The patient with the E coli infection had no prior surgery.

Shoulders with previous nonarthroplasty operations undergoing primary TSA exhibited a significantly higher (P = .016) infection rate compared with shoulders with no operative history. 

Both aTSA and rTSA performed in previously operated-on shoulders demonstrated higher infection rates compared with shoulders with no prior operative intervention. 

Comment: We prepared this chart to make the data from this study a bit easier to grasp.

These data indicate that patients with prior surgery have an increased risk of sustaining an infection after shoulder arthroplasty - information that should be shared with candidates for this procedure.

It is likely that these numbers underestimate the number of infections in that we recognize that Propionibacterium infections may present as pain, stiffness and component loosening many years after the index procedure as described in this post.


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