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Ten questions on prosthetic shoulder infection

Elizabeth M Pinder1, Joshua Cy Ong1, R Stephen Bale1

  • 1Upper Limb Unit, Wrightington Hospital, Wigan, Lancashire, UK.

Shoulder & Elbow
|September 2, 2016
PubMed

Insights

Diagnosing prosthetic shoulder joint infections can be challenging due to subtle symptoms and normal inflammatory markers. Revision arthroplasty offers the best outcomes for these complex cases.

Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Biochemistry

Background:

  • Prosthetic shoulder joint infections lead to significant pain and stiffness, impacting patient morbidity.
  • Diagnosis is often delayed due to absent clinical signs and normal inflammatory markers.
  • Propionibacterium acnes, a common pathogen, requires prolonged incubation for culture, and newer markers lack sensitivity.

Purpose of the Study:

  • To outline a structured approach for assessing prosthetic shoulder joint infections.
  • To review diagnostic challenges and emerging markers.
  • To discuss available treatment options and their associated outcomes.

Main Methods:

  • Comprehensive patient assessment including history, physical examination, and serum inflammatory markers.
  • Radiological evaluation and aspiration/biopsy for microbiological and biochemical analysis.
  • Application of a classification system based on culture, and pre-operative/intra-operative findings.

Main Results:

  • A structured diagnostic approach is essential for accurate prosthetic shoulder infection assessment.
  • Challenges in culturing Propionibacterium acnes and limitations of current biochemical markers are highlighted.
  • A classification system aids in determining infection likelihood.

Conclusions:

  • Effective management of prosthetic shoulder infections requires a systematic diagnostic strategy.
  • Treatment options range from conservative measures to complex revisions.
  • Revision arthroplasty is associated with the most favorable patient outcomes.
Keywords:
Propionibacterium acneschronic infectionclinical assessmentprosthetic shoulder infectionrevision arthroplastyshoulder arthroplasty infection

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