Periprosthetic joint infection of shoulder arthroplasties

Last revised by Daniel J Bell on 2 Apr 2023

Periprosthetic joint infection of shoulder arthroplasties is one of the most common reasons for post-operative revision surgery. Propionibacterium acnes is the most commonly associated organism.

The mean incidence has been reported to be ~1%; although after reverse total shoulder arthroplasty, the incidence is ~4% and can reach up to 10% in the subgroup of young male patients operated on with a reverse prosthesis 1.

Males are ~2.5x increased risk for infection compared to females, and reverse total shoulder arthroplasty is associated with a ~6x increased risk of infection over anatomic total shoulder arthroplasty. Trauma-associated prostheses are associated with a 3x increased risk of infection 1.

Risk factors associated with periprosthetic shoulder infections are 1:

Any pain, stiffness, and/or shoulder prosthesis loosening should be considered as potential infection 1.

Early periprosthetic infections (up to 3 months post-operative) and acute hematogenous infections are usually associated with local and systemic signs of inflammation 1:

  • local signs (e.g. redness, heat) are not always obvious due to the amount of overlying soft tissue

  • systemic signs: increased serum CRP and synovial fluid leukocyte counts (usually >10,000/μL)

In late periprosthetic infections, the local and systemic signs of inflammation are absent so the clinical diagnosis is more difficult to make 1.

Staphylococcus spp. and P. acnes are most commonly associated with periprosthetic shoulder infections, with the latter most commonly being associated with ~50% (range 31-70%), perhaps due to proximity to the axilla 1.

Early implant loosening or osteolyses 1.

For visualizing abscess formations 1.

White cell labeled-scintigraphy does not have higher sensitivity and specificity 1.

For visualizing abscess formations 1.

  • early infections: radical surgical debridement of the periprosthetic tissue and radical synovectomy with a one-stage prosthesis inlay exchange 1

  • late Infections: antibiotics, soft tissue debridement with sine-sine resection arthroplasty, a permanent spacer, and/or one-stage or two-stage septic revision 1

  • antibiotic joint spacer: implantation of antibiotic joint spacer after removal of the infected prosthesis results in much better joint function; the spacer preserves arm length to help preserve soft tissues resulting in better function 1

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