These authors point out that an evidence-based algorithm for treatment of shoulder PJI is lacking in current practice. They conducted a comprehensive literature review to identify studies that reported on single stage revision (13 studies) or two-stage revision (30 studies) with infection eradiation and a minimum follow-up of 12-months and minimum of five patients for analysis.
In the single stage studies, the most common organisms were Cutibacterium (49%), Coagulase-negative Staph (23%), methicillin sensitive staph (11%), methicillin resistant staph (3%). 10% were polymicrobial.
In the two stage studies, the most common organisms were Cutibacterium (34%), Coagulase-negative Staph (20%), methicillin sensitive staph (17%), methicillin resistant staph (10%). 6% were polymicrobial.
The reinfection rate for single stage was 6.3% and 10.1% for two-stage revision (p=0.40).
Comment: As the authors point out, it is difficult to diagnose a definite PJI non-operatively (i.e. without taking cultures or finding pus at surgery unless there is a sinus tract). It is even more difficult to diagnose a "re-infection" without re-operation. Because the most common infecting organism, Cutibacterium, typically does not produce clinical or laboratory signs of inflammation (elevated temperature, WBC, ESR), diagnosing a Cutibacterium re-infection is especially difficult due to their subtle clinical presentation.
Since infections can become evident years after surgery (see this link), a 12 month followup is likely to miss some of them.
Unless there is gross pus or a draining sinus, our approach for an infected arthroplasty is a single stage revision to an impaction allografted hemiarthroplasty, see this link.
For an important example, click on this link.
Unless there is gross pus or a draining sinus, our approach for an infected arthroplasty is a single stage revision to an impaction allografted hemiarthroplasty, see this link.
For an important example, click on this link.
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How you can support research in shoulder surgery Click on this link.
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