Characteristics and outcome of 16 periprosthetic shoulder joint infections
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Shoulder arthroplasties are increasingly performed, but data on periprosthetic joint infections (PJI) in this anatomical position are limited. We retrospectively investigated the characteristics and outcome of shoulder PJI after primary arthroplasty from 1998 to 2010 in a single centre.
Periprosthetic joint infection was defined as periprosthetic purulence, presence of sinus tract or microbial growth. A Kaplan–Meier survival method was used to estimate relapse-free survival of prosthesis.
From 1,571 primary shoulder prostheses, we evaluated 16 patients with a PJI at different stages, i.e, early (n = 4), delayed (n = 6) and late (n = 6) infections. The median patient age was 67 (range 53–86) years, and 69 % were females. The most commonly isolated microorganism was Propionibacterium acnes in 38 % of patients (monobacterial in four and polymicrobial in two patients). In 14 of the 16 patients, surgical interventions consisting of debridement and implant retention (6 patients), exchange (7) and explantation (1) were performed. Four patients had a relapse of infection with P. acnes (n = 3) or Bacteroides fragilis (n = 1). The relapse-free survival of the prosthesis was 75 % (95 % confidence interval 46–90 %) after 1 and 2 years, 100 % in six patients following the treatment algorithm for hip and knee PJI and 60 % in 10 patients not followed up. All but one of the relapses were previously treated without exchange of the prosthesis.
As recommended for hip and knee PJI, we suggest treating shoulder PJI with a low-grade infection by microorganisms such as P. acnes with an exchange of the prosthesis. Cohort studies are needed to verify our results.
- Coste JS, Reig S, Trojani C, Berg M, Walch G, Boileau P. The management of infection in arthroplasty of the shoulder. J Bone Joint Surg Br. 2004;86:65–9.
- Singh JA, Sperling JW, Schleck C, Harmsen W, Cofield RH. Periprosthetic infections after shoulder hemiarthroplasty. J Shoulder Elbow Surg. 2011;21:1304–9. CrossRef
- Sperling JW, Kozak TK, Hanssen AD, Cofield RH. Infection after shoulder arthroplasty. Clin Orthop Relat Res. 2001;382:206–16. CrossRef
- Cuff DJ, Virani NA, Levy J, et al. The treatment of deep shoulder infection and glenohumeral instability with debridement, reverse shoulder arthroplasty and postoperative antibiotics. J Bone Joint Surg Br. 2008;90:336–42. CrossRef
- Cheung EV, Sperling JW, Cofield RH. Infection associated with hematoma formation after shoulder arthroplasty. Clin Orthop Relat Res. 2008;466:1363–7. CrossRef
- Romano CL, Borens O, Monti L, Meani E, Stuyck J. What treatment for periprosthetic shoulder infection? Results from a multicentre retrospective series. Int Orthop. 2012;36:1011–7. CrossRef
- Weber P, Utzschneider S, Sadoghi P, Andress HJ, Jansson V, Muller PE. Management of the infected shoulder prosthesis: a retrospective analysis and review of the literature. Int Orthop. 2011;35:365–73. CrossRef
- Ince A, Seemann K, Frommelt L, Katzer A, Loehr JF. One-stage exchange shoulder arthroplasty for peri-prosthetic infection. J Bone Joint Surg Br. 2005;87:814–8.
- Zimmerli W, Trampuz A, Ochsner PE. Prosthetic-joint infections. N Engl J Med. 2004;351:1645–54. CrossRef
- Zimmerli W, Ochsner PE. Management of infection associated with prosthetic joints. Infection. 2003;31:99–108. CrossRef
- Schwank S, Rajacic Z, Zimmerli W, Blaser J. Impact of bacterial biofilm formation on in vitro and in vivo activities of antibiotics. Antimicrob Agents Chemother. 1998;42:895–8.
- Widmer AF, Frei R, Rajacic Z, Zimmerli W. Correlation between in vivo and in vitro efficacy of antimicrobial agents against foreign body infections. J Infect Dis. 1990;162:96–102. CrossRef
- Zimmerli W, Frei R, Widmer AF, Rajacic Z. Microbiological tests to predict treatment outcome in experimental device-related infections due to Staphylococcus aureus. J Antimicrob Chemother. 1994;33:959–67. CrossRef
- Zimmerli W, Widmer AF, Blatter M, Frei R, Ochsner PE. Role of rifampin for treatment of orthopedic implant-related staphylococcal infections: a randomized controlled trial. Foreign-Body Infection (FBI) Study Group. JAMA. 1998;279:1537–41. CrossRef
- Trampuz A, Hanssen AD, Osmon DR, Mandrekar J, Steckelberg JM, Patel R. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med. 2004;117:556–62. CrossRef
- Zimmerli W, Moser C. Pathogenesis and treatment concepts of orthopaedic biofilm infections. FEMS Immunol Med Microbiol. 2012;65:158–68. CrossRef
- Laffer RR, Graber P, Ochsner PE, Zimmerli W. Outcome of prosthetic knee-associated infection: evaluation of 40 consecutive episodes at a single centre. Clin Microbiol Infect. 2006;12:433–9. CrossRef
- Betsch BY, Eggli S, Siebenrock KA, Tauber MG, Muhlemann K. Treatment of joint prosthesis infection in accordance with current recommendations improves outcome. Clin Infect Dis. 2008;46:1221–6. CrossRef
- Schafer P, Fink B, Sandow D, Margull A, Berger I, Frommelt L. Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis. 2008;47:1403–9. CrossRef
- Versalovic J, Carroll KC, Funke G, et al. (eds). Manual of clinical microbiology, 10th edn. Washington D.C., ASM press, 2011.
- Trampuz A, Piper KE, Jacobson MJ, et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007;357:654–63. CrossRef
- Achermann Y, Vogt M, Spormann C, et al. Characteristics and outcome of 27 elbow periprosthetic joint infections: results from a 14-year cohort study of 358 elbow prostheses. Clin Microbiol Infect. 2011;17:432–8. CrossRef
- Piper KE, Jacobson MJ, Cofield RH, et al. Microbiologic diagnosis of prosthetic shoulder infection using implant sonication. J Clin Microbiol. 2009;47:1878–84. CrossRef
- Kanafani ZA, Sexton DJ, Pien BC, Varkey J, Basmania C, Kaye KS. Postoperative joint infections due to Propionibacterium species: a case–control study. Clin Infect Dis. 2009;49:1083–5. CrossRef
- Topolski MS, Chin PY, Sperling JW, Cofield RH. Revision shoulder arthroplasty with positive intraoperative cultures: the value of preoperative studies and intraoperative histology. J Shoulder Elbow Surg. 2006;15:402–6. CrossRef
- Grosso MJ, Sabesan VJ, Ho JC, Ricchetti ET, Iannotti JP. Reinfection rates after 1-stage revision shoulder arthroplasty for patients with unexpected positive intraoperative cultures. J Shoulder Elbow Surg. 2012;21:754–8. CrossRef
- Marculescu CE, Berbari EF, Hanssen AD, et al. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis. 2006;42:471–8. CrossRef
- Furustrand TU, Corvec S, Betrisey B, Zimmerli W, Trampuz A. Role of rifampin against Propionibacterium acnes biofilm in vitro and in an experimental foreign-body infection model. Antimicrob Agents Chemother. 2012;56:1885–91. CrossRef
- Esposito S, Leone S. Prosthetic joint infections: microbiology, diagnosis, management and prevention. Int J Antimicrob Agents. 2008;32:287–93. CrossRef
- Societe de Pathologie Infectieuse de Langue Francaise. Recommendations for bone and joint prosthetic device infections in clinical practice (prosthesis, implants, osteosynthesis). Med Mal Infect. 2010; 40:185–211.
- Esposito S, Leone S, Bassetti M, et al. Italian guidelines for the diagnosis and infectious disease management of osteomyelitis and prosthetic joint infections in adults. Infection. 2009;37:478–96. CrossRef
- Giulieri SG, Graber P, Ochsner PE, Zimmerli W. Management of infection associated with total hip arthroplasty according to a treatment algorithm. Infection. 2004;32:222–8. CrossRef
- Tsukayama DT, Estrada R, Gustilo RB. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am. 1996;78:512–23.
- Achermann Y, Trampuz A, Moro F, Wust J, Vogt M. Corynebacterium bovis shoulder prosthetic joint infection: the first reported case. Diagn Microbiol Infect Dis. 2009;64:213–5. CrossRef
- Characteristics and outcome of 16 periprosthetic shoulder joint infections
Volume 41, Issue 3 , pp 613-620
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Shoulder arthroplasty
- Prosthetic joint infection
- Surgical management
- Treatment outcome
- Propionibacterium acnes
- Industry Sectors
- Author Affiliations
- 1. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- 5. Department of Microbial Pathogenesis, University of Maryland-Baltimore, 650 W. Baltimore Street, MD 21201, Baltimore, USA
- 2. Department of Internal Medicine, Infectious Diseases Service, Cantonal Hospital Zug, Baar, Switzerland
- 3. Upper Extremity Department, Schulthess Clinic, Zurich, Switzerland
- 4. Microbiology Laboratory Unilabs, Zurich, Switzerland