Wednesday, January 25, 2017

Total shoulder, delayed glenoid failure with positive cultures (not unexpected).

A man had a shoulder arthroplasty for complications of a motorcycle accident 13 years prior to presenting to us. This served him will for 8 years at which time he started having pain but without an clinical evidence of infection. X-rays at that time are shown below showing glenoid osteolysis.

Five years later he presented to us with increased pain, an SST of 1/12 and these x-rays.

At that time he had no clinical or laboratory evidence of infection.

At the time of our revision surgery, the glenoid was grossly loose with substantial osteolysis.

His final culture results are shown below (see this link for explanation of terms: 
Considering the Load of Propionibacterium in Revision Shoulder Arthroplasty).

Note the non-uniform distribution of bacteria in the shoulder as well as the delayed 'stealth' presentation of Propionibacterium years after the index procedure.


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