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Routine cultures for seemingly aseptic revision shoulder arthroplasty: are they necessary?
Tyler J Brolin1, Daniel J Hackett2, Joseph A Abboud1
1Department of Orthopaedic Surgery, Rothman Institute-Thomas Jefferson University, Philadelphia, PA, USA.
Abstract:
Propionibacterium acnes has recently gained attention as the leading cause of periprosthetic joint infections (PJIs) after shoulder arthroplasty. Unlike PJIs in the lower extremity, PJIs after shoulder arthroplasty usually have an indolent course and are notoriously difficult to diagnose. Most of the time, the diagnosis is made after positive intraoperative cultures are taken at the time of revision surgery. Adding even more complexity to the diagnosis is the high rate of P acnes-positive cultures taken at the time of primary shoulder surgery. In many cases the preoperative workup yields no suspicion for infection; however, intraoperative cultures are taken to completely eliminate the potential of an ongoing indolent infection. Concerns over how to interpret positive P acnes culture results and the high rate of culture positivity in primary shoulder arthroplasty, as well as the potentially high rate of contamination, have led surgeons to wonder about the utility of obtaining intraoperative cultures at the time of revision shoulder arthroplasty. We present evidence for and against the practice of obtaining routine intraoperative cultures at the time of seemingly aseptic revision shoulder arthroplasty.
Insights
Propionibacterium acnes causes difficult-to-diagnose shoulder joint infections. This study examines the value of intraoperative cultures in identifying these infections during revision surgery.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Microbiology
Background:
- Propionibacterium acnes is the primary cause of periprosthetic joint infections (PJIs) following shoulder arthroplasty.
- Shoulder PJIs often present insidiously, complicating early diagnosis, with definitive diagnosis frequently occurring during revision surgery.
- High rates of positive P. acnes cultures during primary surgery and potential contamination raise questions about diagnostic utility.
Purpose of the Study:
- To evaluate the evidence supporting and refuting the routine use of intraoperative cultures in revision shoulder arthroplasty.
- To address the diagnostic challenges posed by P. acnes in shoulder arthroplasty infections.
- To clarify the interpretation of positive P. acnes intraoperative cultures.
Main Methods:
- Review of existing evidence regarding intraoperative cultures in shoulder arthroplasty.
- Analysis of P. acnes infection characteristics in shoulder PJI.
- Discussion of diagnostic strategies and interpretation of culture results.
Main Results:
- P. acnes infections in shoulder arthroplasty are often indolent and difficult to diagnose preoperatively.
- Intraoperative cultures are crucial for diagnosing many shoulder PJIs, often identified during revision surgery.
- High rates of positive cultures in primary surgery complicate the interpretation of P. acnes findings.
Conclusions:
- The utility of routine intraoperative cultures in revision shoulder arthroplasty requires careful consideration due to P. acnes.
- Further research is needed to optimize the diagnosis and management of P. acnes shoulder PJIs.
- Balancing the benefits of culture detection against contamination risks is essential for surgical decision-making.
