Characteristics and outcome of 16 periprosthetic shoulder joint infections
- Y. AchermannAffiliated withDivision of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of ZurichDepartment of Microbial Pathogenesis, University of Maryland-Baltimore Email author
- , F. SahinAffiliated withDepartment of Internal Medicine, Infectious Diseases Service, Cantonal Hospital Zug
- , HK SchwyzerAffiliated withUpper Extremity Department, Schulthess Clinic
- , C. KollingAffiliated withUpper Extremity Department, Schulthess Clinic
- , J. WüstAffiliated withMicrobiology Laboratory Unilabs
- , M. VogtAffiliated withDepartment of Internal Medicine, Infectious Diseases Service, Cantonal Hospital Zug
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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.
KeywordsShoulder arthroplasty Prosthetic joint infection Surgical management Treatment outcome Propionibacterium acnes
- Characteristics and outcome of 16 periprosthetic shoulder joint infections
Volume 41, Issue 3 , pp 613-620
- Cover Date
- Print ISSN
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- 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