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General Orthopaedics


Current Concepts in Joint Replacement (CCJR) – Spring 2015


Infection after shoulder surgery is an infrequent but devastating complication with a reported incidence from 0 to 4%. A careful history is critical because many patients have a history of a “stitch abscess” or “superficial wound infection”. Prop. Acnes is the most common organism responsible for infection following rotator cuff surgery, instability surgery, ORIF proximal humerus fractures, and shoulder arthroplasty. This organism typically does not start to grow until Day 5, therefore it is critical to keep cultures a minimum of 10 to 14 days.

The diagnosis can be challenging, principally among patients undergoing revision surgery. The majority of patients with a low grade infection do not have blatant signs of infection such as erythema or sinus tracts. Pre-operative lab values as well as intra-operative pathology have been shown to be unreliable in predicting who will have positive cultures at the time of revision surgery.

There is an assortment of options for treating a patient with a post-operative infection. Important variables include the timing of infection, status of the host, the specific organism, status of implant fixation, and the status of the rotator cuff and deltoid. One of the most frequently employed options for treating the infected shoulder arthroplasty is two stage re-implantation. However, the rate of complications with this technique as well as residual infection remains high.