Periprosthetic joint infections of the shoulder: A 10-year retrospective analysis outlining the heterogeneity among these patients

Taylor Paziuk; Ryan M Cox; Michael J Gutman; Alexander J Rondon; Thema Nicholson; Katherine Belden; Surena Namdari

doi:10.1177/17585732211019010

Periprosthetic joint infections of the shoulder: A 10-year retrospective analysis outlining the heterogeneity among these patients

Shoulder Elbow. 2022 Dec;14(6):598-605. doi: 10.1177/17585732211019010. Epub 2021 Aug 29.

Authors

Taylor Paziuk¹, Ryan M Cox¹, Michael J Gutman¹, Alexander J Rondon¹, Thema Nicholson¹, Katherine Belden², Surena Namdari¹

Affiliations

¹ Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA.
² Department of Infectious Disease, Thomas Jefferson University Hospital, Philadelphia, PA, USA.

Abstract

Background: Diagnosis and treatment of shoulder periprosthetic joint infection is a difficult problem. The purpose of this study was to utilize the 2018 International Consensus Meeting definition of shoulder periprosthetic joint infection to categorize revision shoulder arthroplasty cases and determine variations in clinical presentation by presumed infection classification.

Methods: Retrospective review of patients undergoing revision shoulder arthroplasty at a single institution. Likelihood of periprosthetic joint infection was determined based on International Consensus Meeting scoring. All patients classified as definitive or probable periprosthetic joint infection were classified as periprosthetic joint infection. All patients classified as possible or unlikely periprosthetic joint infection were classified as aseptic. The periprosthetic joint infection cohort was subsequently divided into culture-negative, non-virulent microorganism, and virulent microorganism cohorts based on culture results.

Results: Four hundred and sixty cases of revision shoulder arthroplasty were reviewed. Eighty (17.4%) patients were diagnosed as definite or probable periprosthetic joint infection, of which 29 (36.3%), 39 (48.8%), and 12 (15.0%) were classified as virulent, non-virulent, or culture-negative periprosthetic joint infection, respectively. There were significant differences among periprosthetic joint infection subgroups with regard to preoperative C-reactive protein (p = 0.020), erythrocyte sedimentation rate (p = 0.051), sinus tract presence (p = 0.008), and intraoperative purulence (p < 0.001). The total International Consensus Meeting criteria scores were also significantly different between the periprosthetic joint infection cohorts (p < 0.001).

Discussion: While the diagnosis of shoulder periprosthetic joint infection has improved with the advent of International Consensus Meeting criteria, there remain distinct differences between periprosthetic joint infection classifications that warrant further investigation to determine the accurate diagnosis and optimal treatment.

Keywords: Shoulder arthroplasty; periprosthetic joint infection; revision shoulder arthroplasty.