Abstract
There continues to be significant debate on the optimum treatment of the infected shoulder arthroplasty. Infection after shoulder arthroplasty is an infrequent but devastating complication with a reported incidence from 0 to 4%. The most common organism responsible for infection following rotator cuff surgery, instability surgery, ORIF proximal humerus fractures, and shoulder arthroplasty is P. acnes. A thorough history is important because many patients have a history of difficulty with wound healing or drainage. P. acnes typically does not start to grow until day 5, therefore it is critical to keep cultures a minimum of 10 to 14 days.
Diagnosis can be challenging, particularly among patients undergoing revision surgery. The majority of patients with a low grade infection do not have overt 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 are a number of options for treating a patient with a post-operative infection. Essential 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.
