Shoulder Periprosthetic Joint Infection: Principles of Prevention, Diagnosis, and Treatment

• Published in: Journal of bone and joint surgery. American volume 2024-12, Vol.106 (23), p.2265
• Main Authors: Nazzal, Ehab M, Herman, Zachary J, Como, Matthew, Kaarre, Janina, Reddy, Rajiv P, Wagner, Eric R, Klatt, Brian A, Lin, Albert
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Arthroplasty, Replacement, Shoulder - adverse effects; Debridement - methods; Humans; Prosthesis-Related Infections - diagnosis; Prosthesis-Related Infections - etiology; Prosthesis-Related Infections - prevention & control; Prosthesis-Related Infections - therapy; Reoperation; Shoulder Joint - microbiology; Shoulder Joint - surgery; Shoulder Prosthesis - adverse effects
• ISSN: 0021-9355; 1535-1386; 1535-1386
• DOI: 10.2106/JBJS.23.01073

➢ Shoulder periprosthetic joint infection (PJI) is a potentially devastating complication after arthroplasty and is projected to rise with increasing numbers of performed arthroplasties, particularly reverse shoulder arthroplasties.➢ Important considerations for the diagnosis and treatment of shoulder PJI include age, sex, implant type, primary compared with revision shoulder surgery, comorbidities, and medications (i.e., corticosteroids and disease-modifying antirheumatic drugs). ➢ Diagnosis and management are unique compared with lower-extremity PJI due to the role of lower-virulence organisms in shoulder PJI, specifically Cutibacterium acnes.➢ Treatment pathways depend on chronicity of infection, culture data, and implant type, and exist on a spectrum from irrigation and debridement to multistage revision with temporary antibiotic spacer placement followed by definitive revision arthroplasty.