We had the opportunity of seeing a 47 year old man from Florida with left shoulder discomfort and dysfunction after left shoulder resurfacing performed three years previously. He had done poorly after this procedure and come to us for consideration of revision surgery.
On physical examination, he had notable stiffness with limited active forward elevation to only shoulder height.
His x-rays show what appears to be an Arthrosurface implant in the proximal humerus. There is suggesting of lucency around the implant.
There was also a possible lytic lesion distal to the implant in the humeral canal. We obtained an MRI of the shoulder to evaluate for infection or an oncological process, but the MRI was unremarkable for either.
We were suspicious of a stealth infection, so we performed a single stage revision to a ream and run using impaction allografting for fixation of the component.
Cultures were obtained and the patient was placed on the red protocol (see this link).
His culture results were finalized at three weeks after surgery
IV Ceftriaxone was continued via PICC line for 6 weeks followed by 6 months of Doxycycline.
At 1 year after surgery his shoulder is comfortable and functional with the x-rays shown below.
Comment: This case demonstrates the importance of having a high index of suspicion for a stealth Propionibacterium infection in young male patients with pain and stiffness after an arthroplasty. It also shows the value of a primary prosthesis exchange and immediate vigorous antibiotic management.
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