Saturday, April 29, 2017

Re-revision shoulder arthroplasty and Propionibacterium

Recently we encountered multiple positive cultures for Propionibacterium in three male shoulders that had had prior revisions, but no other clinical or laboratory evidence of infection. In each case we suspected a mechanical rather than an inflammatory cause of the patient's problem. In every revision we obtain cultures and the results are often of interest.

Case 1: Prior revision for glenosphere dissociation. Clinically excellent result for 4 years. Dislocated shoulder while extending arm 3 months prior to revision and desired revision because of persistent pain. Surgical findings benign except for mild poly wear. Pre revision x-ray below.

Case 2: Prior hemiarthroplasty for anchor arthropathy. Initial clinical result for 1 year. Recurrent pain thought to be due to prominent suture anchors. Surgical findings benign except for prominent anchors. Pre revision x-ray below.

Case 3: Prior single stage revision loose glenoid. Positive cultures treated with IV antibiotics. Initially excellent result for two years. Surgical findings benign except for humeral membrane in distal canal. Recurrent pain and stiffness. Pre revision x-ray below.

 The Specimen Propi Values (see this link) for the three cases are shown below.

Comment: These cases again illustrate that cultures for Propionibacterium are not infrequently strongly positive even though there is low clinical suspicion for infection.

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