These authors reviewed 56 patients having revision shoulder arthroplasty. To diagnose or to rule out a PJI, all patients had CRP analysis, white blood cell count and a sterile aspiration of the shoulder joint under fluoroscopic control was performed in all patients. If the aspiration did not yield a positive result and if the symptoms (pain, limited range of motion) had no clear cause (e.g. humeral or glenoid loosening on X-ray, periprosthetic fracture, glenoid wear), an arthroscopic biopsy was performed.
15 of these cases were diagnosed as having a shoulder periprosthetic infection (PJI) from the organisms listed below.
22 of the 56 cases had pre-revision arthroscopic biopsy with histological and culture analysis.
Of the 10 biopsied cases that had PJI, 9 had positive arthroscopic biopsies.
Of the 12 biopsied cases that did not have PJI, 10 had negative arthroscopic biopsies.
Comment: This study provides some evidence of the utility of an arthroscopic biopsy as a part of the pre-revision workup of a failed shoulder arthroplasty. This added procedure may be of value in determining whether complete implant revision should be performed.
