These authors investigated the prevalence of Propionibacterium (P.) acnes in the subcutaneous fat and capsule of 46 patients undergoing shoulder surgery for frozen shoulder or instability. Patients were asked if they have ever had an injection into the shoulder to be operated on, including an injection of contrast for MR arthrogram.
25 patients (53%) had P. acnes in one or more tissue samples and 35 (74%) had other bacterial species. The same microbe was found in the subcutaneous fat and the capsule in 13 patients (28%).
Male gender was significantly associated with an increased capsular colonisation of P. acnes (odds ratio (OR) 12.38, 95% confidence interval (CI) 1.43 to 106.77, p = 0.02).
A pre-operative glenohumeral intra-articular injection - either as treatment for a frozen shoulder or for the injection of contrast in patients with instability - was significantly associated with capsular P. acnes colonisation (OR 5.63, 95% CI 1.07 to 29.61, p = 0.04.
Positive fat colonisation with P. acnes was significantly associated with capsular P. acnes (OR 363, 95% CI 20.90 to 6304.19, p < 0.01).
Patients who had a pre-operative glenohumeral injection who were found intra-operatively to have fat colonisation with P. acnes had a statistically significant association with colonisation of their capsule with P. acnes (OR 165, 95% CI 13.51 to 2015.24, p < 0.01).
These authors concluded that there was a statistically significant association between subcutaneous skin P. acnes culture and P. acnes capsular culture, especially when the patient has undergone a previous injection.
These authors concluded that there was a statistically significant association between subcutaneous skin P. acnes culture and P. acnes capsular culture, especially when the patient has undergone a previous injection.
Comment: This paper provides additional evidence that any invasion of the joint, even an injection, may introduce Propionibacterium into the shoulder. This paper does not provide data on how long prior to the surgery the injections were performed. There is a common believe that shoulder arthroplasty shoulder not be performed within three months of an injection. However, there is no evidence that Propionibacterium introduced by an infection would have been eliminated by host defenses in that period of time. Thus we must ask, does the risk of shoulder colonization after injection decrease with time after injection, or is it long standing?
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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
Use the "Search" box to the right to find other topics of interest to you.
How you can support progress in shoulder surgery
You may be interested in some of our most visited web pages arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
