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Infection Associated With Hematoma Formation After Shoulder Arthroplasty

  • Symposium: Papers Presented at the 2007 Meeting of the Musculoskeletal Infection Society
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Clinical Orthopaedics and Related Research


Hematoma formation requiring operative treatment after shoulder arthroplasty may be associated with higher patient morbidity. We therefore determined whether there was an association of hematoma formation requiring operative treatment with deep infection after shoulder arthroplasty. Between 1978 and 2006, we performed 4147 shoulder arthroplasties in 3643 patients. Of these, 12 shoulders (0.3%) underwent reoperation for hematoma formation. The mean time interval from arthroplasty to surgery for the hematoma was 7 days (range, 0.5–31 days). Among nine cases in which cultures were taken, six had positive cultures; the organisms included Propionibacterium acnes in three, Staphylococcus epidermidis in one, Streptococcus species in one, and Staphylococcus epidermidis with Peptostreptococcus in one. The minimum followup was 12 months (mean, 68 months; range, 12 to 294 months). Two of the 12 patients eventually underwent resection arthroplasty for deep infection. The Neer score was excellent in one, satisfactory in six, and unsatisfactory in five patients. The data suggest hematoma formation after shoulder arthroplasty is often accompanied by positive intraoperative cultures. The surgeon should be aware of the high rate of unsatisfactory results associated with this complication as well as the possibility of developing a deep infection requiring additional surgery.

Level of Evidence: Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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  1. Abudu A, Sivardeen KA, Grimer RJ, Pynsent PB, Noy M. The outcome of perioperative wound infection after total hip and knee arthroplasty. Int Orthop. 2002;26:40–43.

    Article  PubMed  CAS  Google Scholar 

  2. Bauer KA, Eriksson BI, Lassen MR, Turpie AG. Steering Committee of the Pentasaccharide in Major Knee Surgery. Fondaparinux compared with enoxaparin for the prevention of venous thromboembolism after elective major knee surgery. N Engl J Med. 2001;345:1305–1310.

    Article  PubMed  CAS  Google Scholar 

  3. Cofield RH. Total shoulder arthroplasty with the Neer prosthesis. J Bone Joint Surg Am. 1984;66:899–906.

    PubMed  CAS  Google Scholar 

  4. Garvin KL, Hanssen AD. Infection after total hip arthroplasty. J Bone Joint Surg Am. 1995;77:1576–1588.

    PubMed  CAS  Google Scholar 

  5. Neer CS Jr, Watson KC, Stanton FJ. Recent experience in total shoulder replacement. J. Bone Joint Surg Am. 1982;64:319–337.

    PubMed  Google Scholar 

  6. Parker MJ, Livingstone V, Clifton R, McKee A. Closed suction surgical wound drainage after orthopaedic surgery. Cochrane Database Syst Rev. 2007;3:CD001825.

    Google Scholar 

  7. Parker MJ, Roberts CP, Hay D. Closed suction drainage for hip and knee arthroplasty. A meta-analysis. J Bone Joint Surg Am. 2004;86:1146–1152.

    Article  PubMed  Google Scholar 

  8. Saleh K, Olson M, Resig S, Bershadsky B, Kuskowski M, Gioe T, Robinson H, Schmidt R, McElfresh E. Predictors of wound infection in hip and knee joint replacement: results from a 20 year surveillance program. J Orthop Res. 2002;20:506–515.

    Article  PubMed  Google Scholar 

  9. Silva M, Luck JV Jr. Long-term results of primary total knee replacement in patients with hemophilia. J Bone Joint Surg Am. 2005;87:85–91.

    Article  PubMed  Google Scholar 

  10. Smith AM, Barnes SA, Sperling JW, Farrell CM, Cummings JD, Cofield RH. Patient and physician-assessed shoulder function after arthroplasty. J Bone Joint Surg Am. 2006;88:508–513.

    Article  PubMed  Google Scholar 

  11. Sorensen AI, Sorensen TS. Bacterial growth on suction drain tips. Prospective study of 489 clean orthopedic operations. Acta Orthop Scand. 1991;62:451–454.

    Article  PubMed  CAS  Google Scholar 

  12. Sperling JW, Cofield RH, Rowland CM. Neer hemiarthroplasty and Neer total shoulder arthroplasty in patients fifty years old or less. Long term results. J Bone Joint Surg Am. 1998;80:464–473.

    PubMed  CAS  Google Scholar 

  13. Sperling JW, Kozak TK, Hanssen AD, Cofield RH. Infection after shoulder arthroplasty. Clin Orthop Relat Res. 2001;382:206–216.

    Article  PubMed  Google Scholar 

  14. 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;15:402–406.

    Article  PubMed  Google Scholar 

  15. Wirth MA, Rockwood CA. Complications of total shoulder-replacement arthroplasty. J Bone Joint Surg Am. 1996;78:603–616.

    PubMed  CAS  Google Scholar 

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Correspondence to Emilie V. Cheung MD.

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Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Cheung, E.V., Sperling, J.W. & Cofield, R.H. Infection Associated With Hematoma Formation After Shoulder Arthroplasty. Clin Orthop Relat Res 466, 1363–1367 (2008).

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