Wednesday, October 31, 2018

Shoulder joint replacement - young male patients are at increased risk for deep infection

Patient and Procedure-specific Risk Factors for Deep Infection After Primary Shoulder Arthroplasty

These authors sought to identify (1) patient specific risk factors for deep infection, and (2) the pathogen profile after primary shoulder arthroplasty in 3906 patients having primary shoulder arthroplasty in a large integrated healthcare system.

Deep infection was defined as revision surgery for infection supported clinically by more than one of the following criteria: purulent drainage from the deep incision, fever, localized pain or tenderness, a positive deep culture, and/or a diagnosis of deep infection made by the operating surgeon based on intraoperative findings.

During the study period, 45 (1.0%) patients had a diagnosis of deep infection at a median of 212 days
(interquartile range, 67–538 days; mean time, 446 days; range, 12–2227 days).

Risk factors:

Younger age: With every 1-year increase in age, a lower risk of infection was observed. 

Male sex: Male patients had a risk of infection of 2.59 times greater than female patients. 

Reverse total shoulder: Patients undergoing primary reverse total shoulder arthroplasty had a 6.11 times greater risk of infection compared with patients having primary unconstrained total shoulder

Arthroplasty for trauma: Patients having arthroplasty for trauma were 2.98 times  more likely to have an infection develop than patients having elective arthroplasties.

Propionibacterium acnes was the most commonly cultured organism, accounting for 31% of isolates.

Comment: This study was published four years ago, yet its relevance seems even greater today than then.
First, it is of note that the diagnosis of infection was often made a long while after the index arthroplasty: the revision surgeries for infection were performed a median of 7 months later.
Second, the fact that young males are at greater risk for deep infection is consideration for the management of glenohumeral arthritis in this patient subset, whether the arthroplasty is a total shoulder or a ream and run procedure.

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