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Updated: Feb 5, 2026
Reverse Total Shoulder Arthroplasty
Published on: July 5, 2011
[Shoulder arthroplasty complications: case report]
G Luengo-Alonso1, V Jiménez-Díaz1, J Zorrilla-Sánchez De Neyra1
1Hospital Universitario 12 de Octubre, Madrid, España.
Background:
Infection and instability are the complications of prosthetic shoulder surgery of more difficult management. Instability builds up to half of the cases, while the fungal infection accounts for less than 1% of all and can cause severe damage to bone and soft tissue.
Methods:
In this case clinical fungal infection by Candida parapsilosis is presented in a shoulder hemiarthroplasty indicated by a fracture of the proximal humerus. He received surgical treatment in two-stages and administration of fluconazole for eight weeks prior to the second surgical time. In revision surgery was placed a reverse prosthesis as definitive treatment; however, the patient suffered several episodes of dislocation in the postoperative period; a second revision prosthetic surgery was necessary to use more stable components. During this surgery, we extracted samples that were analyzed, obtaining negative results for infection.
Results:
Now after three years of follow-up, the patient is well, no limitations in their daily work and has a Constant Score of 50.5.
Discussion:
We report our experience in this exceptional situation. We know, this is one of the first cases where the fungal infection and dislocation prosthetics in the same patient meet. This situation is a challenge for the surgeon, which has to treat complications two practically at the same time; we do not have scientific evidence to establish a criterion unified for the treatment of complications after surgery for revision of arthroplasty of the shoulder, especially in reverse or mega-denture prosthesis.
Insights
This case study details managing a rare fungal infection and prosthetic dislocation after shoulder hemiarthroplasty. Successful treatment involved staged surgery and revision with a more stable reverse prosthesis.
Area of Science:
- Orthopedic surgery
- Infectious disease
- Prosthetic joint infections
Background:
- Prosthetic shoulder surgery complications include infection and instability, with instability in up to 50% and fungal infections in less than 1%.
- Fungal infections, particularly Candida parapsilosis, can cause significant bone and soft tissue damage.
- Managing simultaneous complications like infection and instability presents a significant surgical challenge.
Observation:
- A patient with a shoulder hemiarthroplasty for proximal humerus fracture developed a clinical fungal infection (Candida parapsilosis).
- Initial two-stage surgical treatment with fluconazole was followed by reverse prosthesis implantation.
- Postoperative dislocation episodes necessitated a second revision surgery with more stable prosthetic components.
Findings:
- Post-revision surgery, samples were negative for infection.
- After three years of follow-up, the patient reported no limitations in daily activities and a Constant Score of 50.5.
- This case represents a rare instance of concurrent fungal infection and prosthetic dislocation in shoulder arthroplasty.
Implications:
- This case highlights the complexity of managing simultaneous prosthetic joint infections and instability in shoulder revision arthroplasty.
- There is a lack of established evidence-based criteria for treating such complex, concurrent complications, especially with reverse or mega-prostheses.
- Further research is needed to develop unified treatment guidelines for these challenging orthopedic scenarios.
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