Skip to main content

Advertisement

SpringerLink
Log in

Infections following arthroscopic rotator cuff repair: incidence, risk factors, and prophylaxis

  • Shoulder
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The primary aim of the present study was to determine the incidence of infections following arthroscopic rotator cuff repair in a single department over a 10-year period. Secondary goals included the evaluation of potential risk factors for infections and to investigate the efficacy of perioperative antibiotic prophylaxis in the reduction of infectious complications.

Methods

A retrospective evaluation of 3294 all-arthroscopic rotator cuff repairs performed between 2004 and 2014 at a single institution was conducted to determine the rate of infection in all-arthroscopic rotator cuff repairs. Detailed data including demographics, co-morbidities, initial surgical procedure, time from index surgery to infection, clinical presentation, isolated pathogens, and subsequent treatment were recorded of patients with infections. Univariate logistic regression was performed, and a multivariate model was developed to identify variables that were predictive of infections following arthroscopic rotator cuff repair.

Results

The rate of infection was 8.5/1000 in whom rotator cuff repairs were performed (95 % CI 0.58–1.23 %) during the study period. The most commonly identified pathogen was Staphylococcus epidermidis (n = 11, 39.3 %), followed by Propionibacterium acnes (n = 8, 28.6 %) and Staphylococcus aureus (n = 2, 7.1 %). Patients presented at our institution with signs of infection an average of 28.9 ± 14.7 days after the index surgery. The leading symptom that was present in all patients was diffuse or localized shoulder pain, followed by local signs of infection in 19 (67.9 %), secretion in 14 (50 %), and fever in 9 (32.1 %) patients, respectively. Univariate and multivariate analyses identified the male gender, age over 60, and duration of surgery over 90 min as predictive factors for infection. Administration of perioperative antibiotic prophylaxis was an independent mitigating factor for postoperative infection and reduced the infection rate from 1.54 % (95 % CI 0.98–2.30 %) to 0.28 % (95 % CI 0.10–0.67 %).

Conclusions

The overall incidence of infection was 8.5/1000 arthroscopic rotator cuff repairs over a 10-year period. Gender, age, and length of surgery were identified as predictive factors for infection. The administration of perioperative antibiotic prophylaxis significantly reduced the overall risk of infection and is therefore recommended in all-arthroscopic rotator cuff repairs. However, current prophylactic treatment strategies were not equally efficient for all types of pathogens.

Level of evidence

Retrospective comparative study, Level III.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Agresti A, Coull BA (1998) Approximate is better than “exact” for interval estimation of binomial proportions. Am Stat 52:119–126

    Google Scholar 

  2. Athwal GS, Sperling JW, Rispoli DM, Cofield RH (2007) Deep infection after rotator cuff repair. J Shoulder Elbow Surg 16:306–311

    Article  PubMed  Google Scholar 

  3. Bartlett JG (2002) Antibiotic-associated diarrhea. N Engl J Med 346:334–339

    Article  PubMed  Google Scholar 

  4. Berjano P, González BG, Olmedo JF, Perez-España LA, Munilla MG (1998) Complications in arthroscopic shoulder surgery. Arthroscopy 14:785–788

    Article  CAS  PubMed  Google Scholar 

  5. Brislin KJ, Field LD, Savoie FH III (2007) Complications after arthroscopic rotator cuff repair. Arthroscopy 23:124–128

    Article  PubMed  Google Scholar 

  6. Crane JK, Hohman DW, Nodzo SR, Duquin TR (2013) Antimicrobial susceptibility of Propionibacterium acnes isolates from shoulder surgery. Antimicrob Agents Chemother 57:3424–3426

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Harbarth S, Samore MH, Carmeli Y (2001) Antibiotic prophylaxis and the risk of C lostridium difficile-associated diarrhoea. J Hosp Infect 48:93–97

    Article  CAS  PubMed  Google Scholar 

  8. Heitmann C, Higgins LD, Levin LS (2004) Treatment of deep infections of the shoulder with pedicled myocutaneous flaps. J Shoulder Elbow Surg 13:13–17

    Article  PubMed  Google Scholar 

  9. Herrera MF, Bauer G, Reynolds F, Wilk RM, Bigliani LU, Levine WN (2002) Infection after mini-open rotator cuff repair. J Shoulder Elbow Surg 11:605–608

    Article  PubMed  Google Scholar 

  10. Hudek R, Sommer F, Abdelkawi AF, Kerwat M, Müller H-H, Gohlke F (2016) Propionibacterium acnes in shoulder surgery: is loss of hair protective for infection? J Shoulder Elbow Surg. doi:10.1016/j.jse.2015.10.018

    Google Scholar 

  11. Iyengar JJ, Samagh SP, Schairer W, Singh G, Valone FH III, Feeley BT (2014) Current trends in rotator cuff repair: surgical technique, setting, and cost. Arthroscopy 30:284–288

    Article  PubMed  Google Scholar 

  12. Jain NB, Higgins LD, Losina E, Collins J, Blazar PE, Katz JN (2014) Epidemiology of musculoskeletal upper extremity ambulatory surgery in the United States. BMC Musculoskelet Disord 15:4

    Article  PubMed  PubMed Central  Google Scholar 

  13. Johnson LL, Shneider DA, Austin MD, Goodman FG, Bullock JM, DeBruin JA (1982) Two per cent glutaraldehyde: a disinfectant in arthroscopy and arthroscopic surgery. J Bone Joint Surg Am 64:237–239

    Article  CAS  PubMed  Google Scholar 

  14. Kurzweil PR (2006) Antibiotic prophylaxis for arthroscopic surgery. Arthroscopy 22:452–454

    Article  PubMed  Google Scholar 

  15. Levy PY, Fenollar F, Stein A, Borrione F, Cohen E, Lebail B, Raoult D (2008) Propionibacterium acnes postoperative shoulder arthritis: an emerging clinical entity. Clin Infect Dis 46:1884–1886

    Article  PubMed  Google Scholar 

  16. Matsen FA, Butler-Wu S, Carofino BC, Jette JL, Bertelsen A, Bumgarner R (2013) Origin of Propionibacterium in surgical wounds and evidence-based approach for culturing propionibacterium from surgical sites. J Bone Joint Surg Am 95(e181):1

    Google Scholar 

  17. McFarland EG, O’Neill OR, Hsu CY (1997) Complications of shoulder arthroscopy. J South Orthop Assoc 6:190–196

    CAS  PubMed  Google Scholar 

  18. Millett PJ, Yen Y-M, Price CS, Horan MP, van der Meijden OA, Elser F (2011) Propionobacter acnes infection as an occult cause of postoperative shoulder pain: a case series. Clin Orthop Relat Res 469:2824–2830

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mirzayan R, Itamura JM, Vangsness CT, Holtom PD, Sherman R, Patzakis MJ (2000) Management of chronic deep infection following rotator cuff repair. J Bone Joint Surg Am 82-A:1115–1121

    Article  CAS  PubMed  Google Scholar 

  20. Olsen MA (2008) Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Joint Surg Am 90:62

    Article  PubMed  Google Scholar 

  21. Oprica C, Nord CE (2005) European surveillance study on the antibiotic susceptibility of Propionibacterium acnes. Clin Microbiol Infect 11:204–213

    Article  CAS  PubMed  Google Scholar 

  22. Patel A, Calfee RP, Plante M, Fischer SA, Green A (2009) Propionibacterium acnes colonization of the human shoulder. J Shoulder Elbow Surg 18:897–902

    Article  PubMed  Google Scholar 

  23. Peersman G, Laskin R, Davis J, Peterson MGE, Richart T (2006) Prolonged operative time correlates with increased infection rate after total knee arthroplasty. HSS J 2:70–72

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Randelli P, Castagna A, Cabitza F, Cabitza P, Cabitza P, Arrigoni P, Denti M (2010) Infectious and thromboembolic complications of arthroscopic shoulder surgery. J Shoulder Elbow Surg 19:97–101

    Article  PubMed  Google Scholar 

  25. Voos JE, Barnthouse CD, Scott AR (2012) Arthroscopic rotator cuff repair. Clin Sports Med 31:633–644

    Article  PubMed  Google Scholar 

  26. Weber SC, Abrams JS, Nottage WM (2002) Complications associated with arthroscopic shoulder surgery. Arthroscopy 18:88–95

    Article  PubMed  Google Scholar 

  27. Wieck JA, Jackson JK, O’Brien TJ, Lurate RB, Russell JM, Dorchak JD (1997) Efficacy of prophylactic antibiotics in arthroscopic surgery. Orthopedics 20:133–134

    CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The authors want to thank Mark P. Cote, P.T., D.P.T., M.C.T.R., Georg Brandl M.D., Fabian Plachel, Nicole Rochla, and Nicolai Thun-Hohenstein for their time and assistance. The study was supported by the independent research organization AURROM (Austrian research group for regenerative orthopedic medicine). PH is a board member of AURROM.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, St. Vincent Hospital Vienna, Stumpergasse 13, 1060, Vienna, Austria

    Leo Pauzenberger, Annemarie Grieb, Michael Hexel, Brenda Laky, Werner Anderl & Philipp Heuberer

Authors
  1. Leo Pauzenberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Annemarie Grieb
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Hexel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brenda Laky
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Werner Anderl
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Philipp Heuberer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philipp Heuberer.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pauzenberger, L., Grieb, A., Hexel, M. et al. Infections following arthroscopic rotator cuff repair: incidence, risk factors, and prophylaxis. Knee Surg Sports Traumatol Arthrosc 25, 595–601 (2017). https://doi.org/10.1007/s00167-016-4202-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-016-4202-2

Keywords

Search

Navigation