High Rates of Occult Infection After Shoulder Fracture Fixation: Considerations for Conversion Shoulder Arthroplasty

HSS Journal Online First Article

Till O. Klatte, MD
Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hambug, Germany

Reza Sabihi
Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany

Daniel Guenther, MD
Trauma Department, Hannover Medical School (MHH), Hannover, Germany

Atul F. Kamath, MD
Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA

Johannes M. Rueger, MD, PhD
Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hambug, Germany

Thorsten Gehrke, MD, PhD
Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany

Daniel Kendoff, MD, PhD
Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany

Abstract

Background
Existing hardware may contribute to increased risk of bacterial contamination and subsequent periprosthetic joint infection (PJI) in conversion shoulder arthroplasty performed for failed fracture fixation.

Questions/Purposes
This study examined the incidence of positive pre-operative aspiration and inflammatory marker data, along with correlation of pre-operative positive aspiration or inflammatory markers and subsequent infection following conversion shoulder arthroplasty for failed open reduction and internal fixation (ORIF) and the need for re-operation at 4.6-year follow-up.

Methods
Twenty-eight patients who underwent conversion to shoulder arthroplasty for any reason after fracture fixation were retrospectively reviewed in a single center. A pre-operative aspiration was done in 17 patients; all patients had intra-operative tissue sampling. All procedures were single-stage removal of hardware and performance of the arthroplasty. In cases of pre-operative positive bacterial growth, a single-stage procedure was performed according to the septic ENDO-Klinik protocol.

Results
In 4 of 17 pre-operative joint aspirations, bacterial growth was detected; one pre-operative negative aspiration demonstrated bacterial growth in intra-operative sampling. In three of them, the infection has been validated through intra-operatively results. Pre-operative aspiration showed a sensitivity of 75% and specificity of 92% (pā€‰<ā€‰0.005) for infection. No post-operative PJIs were observed. Six revisions were performed, most commonly for aseptic loosening (two cases) and conversion of hemiarthroplasty to a reverse design (two cases).

Conclusions
In conclusion, the risk of low-grade shoulder infection after fracture osteosynthesis may be higher than in hip and knee joints, based on limited study data. Adequate pre-operative testing is recommended to rule out occult shoulder infection in this setting.

This Online First article was published online on SpringerLink in June 2015.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal, is published twice a year, February and September, and features articles by internal faculty and HSS alumni that present current research and clinical work in the field of musculoskeletal medicine performed at HSS, including research articles, surgical procedures, and case reports.

 

 

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