Characteristics and outcome of 16 periprosthetic shoulder joint infections

• Published in: Infection Vol. 41; no. 3; pp. 613 - 620
• Main Authors: Achermann, Y., Sahin, F., Schwyzer, HK, Kolling, C., Wüst, J., Vogt, M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01-06-2013; Springer Nature B.V
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Arthroplasty - adverse effects; Arthroplasty - methods; Bacteria - classification; Bacteria - isolation & purification; Bacteroides Infections; Clinical and Epidemiological Study; Family Medicine; Female; General Practice; Humans; Infectious Diseases; Internal Medicine; Male; Medicine; Medicine & Public Health; Microorganisms; Middle Aged; Osteoarthritis - drug therapy; Osteoarthritis - epidemiology; Osteoarthritis - microbiology; Osteoarthritis - pathology; Prosthesis-Related Infections - drug therapy; Prosthesis-Related Infections - epidemiology; Prosthesis-Related Infections - microbiology; Prosthesis-Related Infections - pathology; Retrospective Studies; Shoulder Joint - microbiology; Shoulder Joint - pathology; Survival Analysis; Treatment Outcome; Surgical management; Treatment outcome; Shoulder arthroplasty; Prosthetic joint infection
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-012-0360-4

Purpose
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.
Methods
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.
Results
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.
Conclusions
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.