Postoperative deep shoulder infections following rotator cuff repair

Abstract

Rotator cuff repair (RCR) is one of the most commonly performed surgical procedures in orthopaedic surgery. The reported incidence of deep soft-tissue infections after RCR ranges between 0.3% and 1.9%. Deep shoulder infection after RCR appears uncommon, but the actual incidence may be higher as many cases may go unreported. Clinical presentation may include increasing shoulder pain and stiffness, high temperature, local erythema, swelling, warmth, and fibrinous exudate. Generalized fatigue and signs of sepsis may be present in severe cases. Varying clinical presentation coupled with a low index of suspicion may result in delayed diagnosis. Laboratory findings include high erythrocyte sedimentation rate and C-reactive protein level, and, rarely, abnormal peripheral blood leucocyte count. Aspiration of glenohumeral joint synovial fluid with analysis of cell count, gram staining and culture should be performed in all patients suspected with deep shoulder infection after RCR. The most commonly isolated pathogens are Propionibacterium acnes, Staphylococcus epidermidis, and Staphylococcus aureus. Management of a deep soft-tissue infection of the shoulder after RCR involves surgical debridement with lavage and long-term intravenous antibiotic treatment based on the pathogen identified. Although deep shoulder infection after RCR is usually successfully treated, complications of this condition can be devastating. Prolonged course of intravenous antibiotic treatment, extensive soft-tissue destruction and adhesions may result in substantially diminished functional outcomes.

The effect of deep shoulder infections on patient outcomes after arthroscopic rotator cuff repair: a retrospective comparative study

“…Rotator cuff repair (RCR) is one of the most frequently performed orthopaedic procedures, and arthroscopic repair has become the procedure of choice for the last two decades, with good or excellent clinical outcomes in approximately 90% of patients [1][2][3][4] . The data obtained from the National Hospital Discharge Survey and the National Survey of Ambulatory Surgery indicate that the number of rotator cuff repairs increased 141% between 1996 to 2006 in the United States 2 .…”

“…Interestingly, the number of arthroscopic repairs increased by 600%, whereas open repairs increased by only 34% during the same period 2 . Due to the exponential increase in the number of arthroscopic RCRs, complications may be encountered more frequently 1 . Postoperative deep shoulder infections after arthroscopic RCR appear to be a rare complication, with a reported incidence of 8.5/1000 5 .…”

“…Studies indicate that post-RCR deep infections may result in abscess formation, osteomyelitis, post-infectious glenohumeral arthritis, and loss of the soft tissue envelope 1,[6][7][8] . Although some of the studies in which open or mini-open RCR techniques were used, confirm poor outcomes as a result of post-operative infections 1,[6][7][8] , no studies to date have reported deleterious effects of deep infections after arthroscopic RCRs on functional outcomes, time to return to work, or time to start physiotherapy in comparison with a control group. The purpose of this investigation was to evaluate the effects of deep shoulder infections after arthroscopic RCR on patient outcomes and compare the results with those of a matched group of patients who did not develop infections after arthroscopic RCR.…”

Exploring Penicillin G as an Intrawound Antibiotic Powder for Prevention of Postoperative Shoulder Infections: Does It Exhibit In Vitro Chondrotoxicity?

“…SSIs carry with them significant morbidity to the patient with chronic pain, prosthetic instability, and sepsis as well as significant health‐care costs . Although SSIs are most commonly reported following shoulder arthroplasty procedures, they can occur following operative procedures on native joints as well, such as instability procedures, rotator cuff repairs, and fracture fixation …”

“…4,5 Although SSIs are most commonly reported following shoulder arthroplasty procedures, they can occur following operative procedures on native joints as well, such as instability procedures, rotator cuff repairs, and fracture fixation. [6][7][8] Cutibacterium acnes (C. acnes), formerly known as Propionibacterium acnes, has been recognized as the leading pathogen responsible for SSIs in shoulder arthroplasty 9 . C. acnes colonizes hair follicles and sebaceous glands found around the shoulder.…”