Thursday, October 6, 2016

Irrigation and Drainage for Shoulder Arthroplasty Infection

Management of acute or late hematogenous infection after shoulder arthroplasty with irrigation, débridement, and component retention.

These authors report on 10 shoulders (9 patients) who underwent irrigation and débridement (I&D with component retention for the management of an acute or delayed-onset acute deep periprosthetic shoulder infection (PSI).

Deep infection recurred in 3 shoulders, which were eventually treated with resection arthroplasty. Of the remaining 6 patients (7 shoulders), 5 were prescribed chronic antibiotic suppression.

Comment: While these infections were thought to be 'hematogenous', the sources of the infection were not identified. It seems possible that some of these infections may have resulted from bacteria introduced into the wound directly at the time of the index arthroplasty with delayed onset as explained in this link.

Of those shoulders with failed I&D, the eventual treatment was resection arthroplasty. We have found that single stage exchange can be effective in the management of Propionibacterium PSI as shown in this link.

The bacteria involved in this historical series of cases from 1980 to 2010 were commonly S. aureus in contrast to the most commonly recovered organism in current times: Propionibacterium  as detailed here.

Some of the elements of our current approach to shoulder PSI are presented in this link.