Wednesday, February 12, 2020

Total shoulder - Cutibacterium infection 9 years later, treated with a ream and run

A middle aged man presented with pain and stiffness of the shoulder that had been progressive for the nine years after a total shoulder.

His x-rays show a radiolucent line around the humeral component. There was no evidence of glenoid component loosening,

In clinic we cultured his skin, which showed 1+ growth for each of two types of Cutibacterium and 1+ growth of coagulase negative Staph. These data, combined with his clinical and radiographic findings suggested a high risk for periprosthetic infection. We proceeded to a single stage revision of his total shoulder to a ream and run procedure with impaction allograft and Vancomycin beads. The patient was started on the Red antibiotic protocol (see this link).

 At surgery before the prep, the a skin swab showed 2+ growth of two different types of Cutibacterium. Cultures of the freshly incised dermis showed 2+ and 3+ growth of two different types of Cutibacterium. The humeral head explant grew two different types of Cutibacterium and the glenoid explant grew one type of Cutibacterium. The humeral body grew out 2+ cutibacterium.

Comment: It is a difficult decision to remove a well-fixed glenoid component. However, the positive glenoid explant supports its removal.

To see a YouTube of our technique for total shoulder arthroplasty, click on this link.

We have a new set of shoulder youtubes about the shoulder, check them out at this link.

Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link

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