Advertisement

Analysis of infection in shoulder arthroplasty: a multicentre study

  • Rajkumar S. Amaravathi
  • Jean Kany
  • Myriam Melet
  • Denis Katz
  • Philippe Sauzieres
  • Philippe Valenti
  • Jean Marc Gandois
Original Article

Abstract

Background

The purpose of this paper is to analyze 44 patients with infected shoulder arthroplasties from different centers.

Methods

The patients were followed up for at least 2 years or until revision surgery from the year 1993 to 2008.

Result

The mean follow-up of patients was 30 months. Microorganisms taken from 34 of the 44 patients were cultured. The most common was Propionibacterium acnes (36%), and the less common Staphylococcus aureus or a combination with P. acnes (5%) each. No microorganisms from 23% of the patients were cultured. In 69% of the patients, no loosening of the components was noted, and only 27% of the revised patients needed further revision. Complications occurred in 22% of the patients like fistula, instability, implant failure, and one patient died. Good healing of the wound was noted in 77% of the patients. Constant score showed nice progression with regard to pain before and after surgery. One- or two-stage revision procedures led to identical results.

Conclusion

Infection can occur even without any history of previous shoulder surgery. Propionibacterium acnes and Staphylococcus epidermidis were frequently cultured organisms. There was no difference in the results of single- or two-stage revision procedures.

Level of evidence

4, case series, treatment.

Keywords

Infection Shoulder arthroplasty Complication 

Notes

Conflict of interest

None.

References

  1. 1.
    Amar P, Calfee RP, Plante M, Fischer SA, Green A (2009) Propionibacterium acnes colonization of the human shoulder. J Shoulder Elbow Surg 18:897–902. doi: 10.1016/j.jse.2009.01.023 CrossRefGoogle Scholar
  2. 2.
    Antunna SA, Sperling JW, Cofield RH, Rowland CM (2001) Glenoid revision surgery after total shoulder arthroplasty. J Shoulder Elbow Surg 10:217–224. doi: 10.1067/mse.2001.113961 CrossRefGoogle Scholar
  3. 3.
    Bicknell R, Boileau P, Chuinard C, Jacquot N (2009) Results of deep infection after reverse shoulder arthroplasty. J Bone Joint Surg (Br) 91(issue supp II):245–246Google Scholar
  4. 4.
    Christopher CD, Craig VE, Cordasco FA, Dines DM, Dines DS, Dicarlo E, Brause BD, Warren RF (2010) Propionibacterium acnes infection after shoulder arthroplasty; A diagnostic challenge. J Should Elb Surg 19:303–307. doi: 10,1016/j.jse.2009.07.065 CrossRefGoogle Scholar
  5. 5.
    Clare DJ, Wirth MA, Groh GI, Rockwood CA Jr (2001) Shoulder arthrodesis. J Bone Joint Surg (Am) 83:593–600 (PMID 1131579)Google Scholar
  6. 6.
    Codd TP, Yamaguchi K, Flatlow EL (1996/1997) Infected shoulder arthroplasties: treatment with staged reimplantation versus resection arthroplasty. Orthop Trans 20:59Google Scholar
  7. 7.
    Cofield RH, Edgerton BL (1990) Total shoulder arthroplasty: complications and revision surgery. Instr Course Lect 39:449–462 (PMID 2186136)Google Scholar
  8. 8.
    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164 (PMID 3791738)Google Scholar
  9. 9.
    Coste JS, Reig S, Trojani C, Berg M, Walch G, Boileau P (2004) The management of infection in arthroplasty of the shoulder. J Bone Joint Surg (Br) 86(1):65–69 (PMID 14765868)Google Scholar
  10. 10.
    Cuff DJ, Virani NA, Levy J, Frankle MA, Derasari A, Hines B, Pupello DR, Cancio M, Mighell M (2008) The treatment of deep shoulder infection and glenohumeral instability with debridement, reverse shoulder arthroplasty, and postoperative antibiotics. J Bone Joint Surg (Br) 90(3):336–342 (PMID 18310757)Google Scholar
  11. 11.
    Gorman MT, Crosby LA (2006) Treatment of deep infection after total shoulder arthroplasty with an antibiotic impregnated cement spacer. Tech Should Elb Surg 7(2):82–85. doi: 10.1097/00132589-200606000-00002 CrossRefGoogle Scholar
  12. 12.
    Gravin KL, Hanssen AD (1995) Infection after total hip arthroplasty. Past, present and future. J Bone Joint Surg (Am) 77(10):1576–1588 (PMID 7593069)Google Scholar
  13. 13.
    Ince A, Seemann K, Frommett L, Katzer A, Loehr JF (2005) One stage exchange shoulder arthroplasty for periprosthetic infection. J Bone Joint Surg (Br) 87(6):814–818 (PMID 15911665)Google Scholar
  14. 14.
    Neer II CS, Kirby RM (1982) Revision of humeral head and total shoulder arthroplasties. Clin Orthop Relat Res 170:189–195 (PMID 7127946)Google Scholar
  15. 15.
    Rao N, Crosett LS, Sinha RK, Lefrock JL (2003) Long-term suppression of infection in total joint arthroplasty. Clin Orthop Relat Res 414:55–60 (PMID 12966277)Google Scholar
  16. 16.
    Rispoli DM, Sperling JW, Atwal GS, Schleck CD III, Cofield RH (2007) Pain relief and functional results after resection arthroplasty of shoulder. J Bone Joint Surg (Br) 89(9):1184–1187 (PMID 17905955)Google Scholar
  17. 17.
    Spangehl MJ, Masri BA, O’ Connell JX, Duncan CP (1999) Prospective analysis of preoperative and intra operative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg (Am) 81(5):672–683 (PMID 17905955)Google Scholar
  18. 18.
    Sperling JW, Cofield RH, O’Driscoll SW, Torchia ME, Rowland CM (2000) Radiographic assessment of ingrowth in total shoulder arthroplasty. J Should Elb Surg 9:507–513. doi: 10.1067/mse.2000.109384 Google Scholar
  19. 19.
    Sperling JW, Kozak TK, Hanssen AD, Cofield RH (2001) Infection after shoulder arthroplasty. Clin Orthop Relat Res 382:206–216 (PMID 11153989)Google Scholar
  20. 20.
    Strickland JP, Sperling JW, Cofield RH (2008) The results of two stage re-implantation for infected shoulder replacement. J Bone Joint Surg (Br) 90(4):460–465 (PMID 18378920)Google Scholar
  21. 21.
    Topolski MS, Chin PY, Sperling JW, Cofield RH (2006) Revision shoulder arthroplasty with positive intraoperative cultures: the value of preoperative studies and intraoperative histopathology. J Should Elb Surg 15:402–406. doi: 10.1016/j.jse.2005.10.001 Google Scholar
  22. 22.
    Unglaub F, Guehring T, Ficks PC, Perez-Bouza A, Groger A, Pallua N (2005) Necrotising fasciitis following therapeutic injection in a shoulder joint. Orthopaedic 34(3):250–252 (In German) (PMID 15703892)Google Scholar
  23. 23.
    Wirth MA, Rockwood CA Jr (1994) Complications of shoulder arthroplasty. Clin Orthop Relat Res 307:47–69 (PMID 7924048)Google Scholar
  24. 24.
    Wolfe SW, Figgic MP, Inglis AE, Bohn WW, Ranawat CS (1990) Management of infection about total elbow prosthesis. J Bone Joint Surg (Am) 72(2):198–212 (PMID 2303506)Google Scholar
  25. 25.
    Yamaguchi K, Adams RA, Morrey BF (1998) Infection after total elbow arthroplasty. J Bone Joint Surg (Am) 80(4):481–491 (PMID 9563377)Google Scholar
  26. 26.
    Zalavras CG, Patzakis MJ (2003) Open fractures: evaluation and management. J Am Acad Orthop Surg 11(3):212–219 (PMID 12828451)Google Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Rajkumar S. Amaravathi
    • 1
  • Jean Kany
    • 2
  • Myriam Melet
    • 2
  • Denis Katz
    • 3
  • Philippe Sauzieres
    • 4
  • Philippe Valenti
    • 4
  • Jean Marc Gandois
    • 2
  1. 1.St Johns Medical College and HospitalBangaloreIndia
  2. 2.Clinique de L’UnionToulouseFrance
  3. 3.Clinique de PloemeurLorientFrance
  4. 4.Clinique JouvenetParisFrance

Personalised recommendations