Following this procedure, he noted worsening in his range of motion and pain in the left shoulder. In particular his pain was located posteriorly at inferior to the shoulder joint as well as anterior at the level of the coracoid. He participated in 2 years of physical therapy of his left shoulder including range of motion and stretching exercises with minimal improvement. In 2016 he had an arthroscopic lysis of adhesions, subacromial decompression, subacromial bursectomy, acromioplasty combined with manipulation under anesthesia. This unfortunately did not resolve his symptoms as he continued to have limitation range of motion and pain in his left shoulder.
He had received 2 injections of corticosteroid into his left shoulder in the past year, one 7 months prior and the other 3 months prior. These did not produce significant change or improvement in his symptomatology. He was taking 600 mg of ibuprofen nightly with limited relief. Often awakened at night.
At the time of his visit with us - 3 years after his resurfacing - he had a very stiff painful shoulder and could perform only 3 of the 12 functions of the simple shoulder test. These were his x-rays.
His AP view showed some subtle endosteal bone resorption.
An MRI of his humeral shaft showed no abnormal bone marrow signal within the left humerus. There is no evidence of surrounding soft tissue edema. His blood tests were all normal.
He was revised to an impaction allografted ream and run arthroplasty after intraoperative cultures were obtained. His resurfacing implant was not loose and there were no gross intraoperative signs of infection. although histology showed >5 WBC/HPF.
He was placed on the red protocol (see this link) because of our suspicion for infection.
The results of his Propionibacterium specific cultures are shown below (see this link for an explanation of the Propionibacterium load in this shoulder)
He will have a 6 week course of IV Ceftriaxone followed by oral Augmentin for 6 months.
Recently he sent this email and photos
"It’s been 4 weeks after my surgery, shoulder feels good sometimes more sore than the other day but good. I started doing the one with me laying down on the floor on a mat to get more extension than on a bed. I’m on the antibiotics, everything is good."
Comment: This is a classic 'stealth' presentation of Propi. In our practice, we suspect Propionibacterium in all failed arthroplasties, especially in young male patients - even if they present, as in this case, years after the index procedure.
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