Scoping review: Diagnosis and management of periprosthetic joint infection in shoulder arthroplasty

Abstract

Background: The aim of this scoping review is to assess the current evidence regarding periprosthetic shoulder infection to inform development of evidence and consensus-based guidelines. Methods: A search of Medline, Embase and PubMed was performed; two authors screened the results independently for inclusion. Results: Totally 88 studies were included. Incidence of periprosthetic shoulder infection ranged from 0.7% to 7%. The most common organisms to cause periprosthetic shoulder infection were Propionibacterium acnes, Staphylococcus aureus, Staphylococcus epidermidis and coagulase-negative Staphylococcus. Male gender and younger age are the most reported risk factors. Erythrocyte sedimentation rate, C-reactive protein and serum/synovial biomarkers had limited diagnostic accuracy. Thirty-nine studies reported the outcome of surgical management of periprosthetic shoulder infection. Eradication rates vary from 54% to 100% for debridement procedures; 66-100% for permanent spacers; 50-100% following single-stage revision; 60-100% following two-stage revision; and 66-100% following resection arthroplasty. Conclusion: There is wide heterogeneity in study designs and outcomes of studies are often contradictory and due to issues with methodology and small sample sizes the optimal pathways for diagnosis and management cannot be determined from this review. Future research should be based on larger cohorts and randomised trials where feasible to provide more valid research for guiding future treatment of periprosthetic shoulder infection.

Prosthetic Shoulder Joint Infection by Cutibacterium acnes: Does Rifampin Improve Prognosis? A Retrospective, Multicenter, Observational Study

“…Previous studies have argued that the shoulder has a propensity for infection with C. acnes because it is the anaerobic dominant bacteria from healthy skin, particularly in moist areas (axilla), where a higher C. acnes bacterial burden is observed in men compared to women [ 17 , 18 , 19 ]. Moreover, previous series have reported that male gender is a risk factor for the development of this infection [ 1 , 9 , 20 ]. These previous findings would explain our results in which a male predominance of PJI was observed.…”

“…Previous surgery in the same joint has been linked to an increased risk of C. acnes -related PJI because repeated manipulation of the joint causes changes in the anatomical structure; this increases the duration of surgery, which is a major risk factor for shoulder PJI from this microorganism [ 20 , 24 , 25 ]. We observed that previous prosthesis, infection, or surgery in the same joint might be related with recurrence, but we could not demonstrate a significant association, possibly due to small sample size.…”

Clinical Outcome of Two-Stage Revision after Periprosthetic Shoulder Infection

“…Several influencing risk factors, such as bone and soft tissue status, comorbidities, socioeconomic status, age and gender, that may predispose for PJI are discussed [ 5 ]. However, male gender and young age at primary implantation were identified as the most important influencing factors [ 6 , 7 ]. It is reported that the incidence of PJI following primary SA ranges from 0 to 4% [ 8 , 9 ].…”

Investigation and Management of Periprosthetic Joint Infection in the Shoulder and Elbow: Evidence and consensus based guidelines of the British Elbow and Shoulder Society

“…Scoping reviews of the current body of literature on shoulder and elbow PJI confirmed a limited quality of published papers, mostly based on small retrospective case series and cohort studies. 5,6 The British Elbow and Shoulder Society (BESS) has therefore developed these clinical guidelines on investigation and management of shoulder and elbow PJI by combining available evidence from the literature with consensus developed by a working group of BESS surgeons, infectious disease physicians and BESS physiotherapists.…”