Because of his active lifestyle he elected a ream and run arthroplasty. His six week postoperative films show centering of the humeral prosthesis in a concave glenoid.
Following this procedure, the patient was able to return to regular competitive swimming at the master’s level.
Five years after his index arthroplasty, he returned to the office with complaints of the insidious onset of pain and stiffness without an identified explanation (what we refer to is the "Honeymoon" phenomenon). His Simple Shoulder Test score was 3 out of 12. His CBC, sedimentation rate and C-reactive protein were all within normal limits. His radiographs showed glenoid erosion.
One year after his revision arthroplasty his Simple Shoulder Test score was 11 out of 12. His radiographs showed showed a centered humeral head with radiographic joint space between the humeral head and the glenoid.
Five years after his index arthroplasty, he returned to the office with complaints of the insidious onset of pain and stiffness without an identified explanation (what we refer to is the "Honeymoon" phenomenon). His Simple Shoulder Test score was 3 out of 12. His CBC, sedimentation rate and C-reactive protein were all within normal limits. His radiographs showed glenoid erosion.
Six years after his index arthroplasty he had a single stage revision. At the time of his revision he was 55 years of age, ASA 2, BMI 24. The preoperative Propionibacterium cultures of his unprepared skin over the area of the prior incision were strongly positive with a EpidermalSpPV of 2. His intraoperative findings included synovitis. His revision was followed by six weeks of intravenous antibiotic treatment (Ceftriaxone) and 6 months of Augmentin. At 3 weeks after surgery his eight deep intraoperative cultures were strongly positive with a total Propionibacterium score (ShPS) of 7.4.
One year after his revision arthroplasty his Simple Shoulder Test score was 11 out of 12. His radiographs showed showed a centered humeral head with radiographic joint space between the humeral head and the glenoid.
He has returned to his regular swimming program
Comment: This article demonstrates the common presentation of Propionibacterium infection of shoulder arthroplasty. The patient is typically a young, healthy, lean, athletic male. After a post-arthroplasty "honeymoon" period of excellent function lasting months or years, the patient experienced the insidious onset of pain and stiffness without evidence of systemic inflammation. Preoperative cultures of the unprepared skin surface were strongly positive for Propionibacterium. At the time of surgical revision, deep tissue and explant cultures were strongly positive for Propionibacterium. The revision was a single stage prosthesis exchange followed by immediate intravenous antibiotics, avoiding the complexities of a two stage revision.
Because Propionibacterium can manifest themselves years after surgery, we can never be 100% confident that the infection has been "cured".
Because Propionibacterium can manifest themselves years after surgery, we can never be 100% confident that the infection has been "cured".
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