Saturday, April 8, 2017

Early return to swimming after single stage revision for Propionibacterium infection

An active man in his early 50s presented six years ago with severe arthritis of his right shoulder and severe posterior decentering on the axillary 'truth' view.


He elected to proceed with a ream and run procedure. His 6 week postoperative films show a re-centered humeral head on the axillary 'truth' view.



Seven months after his ream and run he returned to swimming as shown in this link.

After having more than five years of excellent postoperative comfort and function, the shoulder became stiff and painful without apparent explanation. We were concerned that this was the 'stealth' presentation of a Propionibacterium infection after a honeymoon, as explained in this link.

He elected to proceed with a single stage exchange (see this link) with humeral component fixation using impaction allografting followed by 6 weeks of intravenous antibiotics (Ceftriazone) started immediately postoperatively with 6 months of oral antibiotics (the red protocol, see this link).

By three weeks after surgery, his culture results were finalized as shown below. To review the importance of the Specimen Propi Value, Shoulder Propi Score and Average Specimen Value see this link.



 His post revision x-rays are shown below.


 He recently sent this email. "As you can see from the attached video, I am getting through the range of motion in backstroke and am working on my strength. This is 9 weeks after my right shoulder revision. I will send separate messages with breast stroke and my first 50 yards of freestyle. I have also been able to do 2000 meters on a rowing machine in 8:15 and do 2x20 lat pull downs with 55 pounds" 

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This is a very early result in a very well motivated patient. Long term followup will reveal the ultimate success of the procedures.

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Consultation for those who live a distance away from Seattle.

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