Y Achermann1, F Sahin, H K Schwyzer, C Kolling, J Wüst, M Vogt. 1. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. yvonne.achermann@gmail.com
Abstract
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.
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.
Authors: Matthew J Grosso; Vani J Sabesan; Jason C Ho; Eric T Ricchetti; Joseph P Iannotti Journal: J Shoulder Elbow Surg Date: 2012-02-03 Impact factor: 3.019
Authors: S Esposito; S Leone; M Bassetti; S Borrè; F Leoncini; E Meani; M Venditti; F Mazzotta Journal: Infection Date: 2009-11-10 Impact factor: 7.455
Authors: Daniel A Bossard; Bruno Ledergerber; Patrick O Zingg; Christian Gerber; Annelies S Zinkernagel; Reinhard Zbinden; Yvonne Achermann Journal: J Clin Microbiol Date: 2016-10-12 Impact factor: 5.948
Authors: Matthias D Wimmer; Thomas M Randau; Sabine Petersdorf; Geert I Pagenstert; Markus Weißkopf; Dieter C Wirtz; Sascha Gravius Journal: Int Orthop Date: 2013-07-13 Impact factor: 3.075
Authors: Florian Grubhofer; Mohamed A Imam; Karl Wieser; Yvonne Achermann; Dominik C Meyer; Christian Gerber Journal: Clin Orthop Relat Res Date: 2018-01 Impact factor: 4.176