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Updated: Mar 8, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Characterizing the Propionibacterium Load in Revision Shoulder Arthroplasty: A Study of 137 Culture-Positive Cases
Zahab S Ahsan1, Jeremy S Somerson, Frederick A Matsen
11Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington 2University of Texas Medical Branch, Galveston, Texas.
Background:
Propionibacterium is commonly recovered from explants or surrounding tissues in revision shoulder arthroplasty. Rather than attempting to differentiate a true infection from a false-positive result on the basis of the number of positive cultures, we characterized the amount of these bacteria in each specimen and shoulder.
Methods:
The study included 137 revision shoulder arthroplasties from which a minimum of 4 specimens had been submitted for culture and at least 1 was positive for Propionibacterium. Standard microbiology procedures were used to assign a semiquantitative value (0.1, 1, 2, 3, or 4), called the Specimen Propi Value, to the amount of growth in each specimen. The sum of the Specimen Propi Values for each shoulder was defined as the Shoulder Propi Score, which was then divided by the total number of specimens to calculate the Average Shoulder Propi Score.
Results:
The number and percentage of positive specimen-specific cultures (of material obtained from the stem explant, head explant, glenoid explant, humeral membrane, collar membrane, other soft tissue, fluid, or other) per shoulder ranged from 1 to 6 and 14% to 100%. A high percentage of specimens (mean, 43%; median, 50%) from the culture-positive shoulders showed no growth. Only 32.6% of the fluid cultures were positive in comparison with 66.5% of the soft-tissue cultures and 55.6% of the cultures of explant specimens. The average Specimen Propi Value (and standard deviation) for fluid specimens (0.35 ± 0.89) was significantly lower than those for the soft-tissue (0.92 ± 1.50) and explant (0.66 ± 0.90) specimens (p < 0.001). The Shoulder Propi Score was significantly higher in men (3.56 ± 3.74) than in women (1.22 ± 3.11) (p < 0.001). Similarly, men had a significantly higher Average Shoulder Propi Score (0.53 ± 0.51) than women (0.19 ± 0.43) (p < 0.001).
Conclusions:
This investigation suggests that Propionibacterium is unevenly distributed within culture-positive revised shoulders. As a result, the specimen number and source (explant, soft tissue, or fluid) have major influences on the culture results for a revised shoulder arthroplasty. We found no evidence that suggested useful threshold values for defining a true infection.
Level Of Evidence:
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Insights
Propionibacterium is unevenly distributed in revision shoulder arthroplasty, influencing culture results. Specimen source significantly impacts bacterial detection, with no clear thresholds for true infection identified.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Microbiology
Background:
- Propionibacterium is frequently detected in revision shoulder arthroplasty cases.
- Differentiating true infection from contamination is challenging based solely on positive culture counts.
Purpose of the Study:
- To characterize the quantity of Propionibacterium in various specimens from revision shoulder arthroplasty.
- To assess the influence of specimen type and location on bacterial detection.
Main Methods:
- 137 revision shoulder arthroplasties with at least one positive Propionibacterium culture were analyzed.
- A semiquantitative Specimen Propi Value was assigned to bacterial growth in each sample.
- Shoulder Propi Scores were calculated to quantify bacterial load per shoulder.
Main Results:
- Propionibacterium exhibited uneven distribution across specimens (explant, soft tissue, fluid).
- Soft tissue and explant cultures yielded higher bacterial loads than fluid cultures.
- Men showed significantly higher bacterial loads (Shoulder Propi Score) than women.
Conclusions:
- Bacterial distribution in revision shoulder arthroplasty is heterogeneous.
- Specimen source and number significantly affect Propionibacterium culture outcomes.
- No reliable threshold values were found to definitively diagnose true infection.
