We preformed a revision arthroplasty with a single-stage exchange and the red protocol (see this link). Going in to surgery, we thought we were dealing with 'aseptic' loosening of the stem. However , pathology revealed a humeral membrane with greater than 5 neutrophils in at least 5 high-powered fields, with chronic inflammation and focal foreign body giant cell reaction, and another humeral membrane that showed fibrinous tissue with chronic inflammation, but only rare neutrophils. Two synovial fluid specimens were sent for analysis, including the initial fluid specimen with 15,050 white blood cells (83% neutrophils,) and 3440 red cells. The culture results were: fluid: one colony Propi, humeral membrane 1+ Propi, stem explant 1+ Propi, and head explant 1+ Propi. After thorough debridement, a new prosthesis was inserted with Vancomycin soaked allograft.
After 5 weeks of intravenous vancomycin and oral rifampin, the antibiotics were discontinued because of neutropenia from which he recovered completely.
Recently we saw him back five years after his single stage revision. He had full function and no discomfort in his right shoulder.
He presented to have his opposite side managed with a ream and run. This time we plan our current standard prophylaxis of Ceftriaxone and Vancomycin.
Comment: This case demonstrates the 'honeymoon' period than can be associated with Propionibacterium.
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