Hypothesis Among patients undergoing shoulder arthroplasty (SA), female patients would have worse outcomes than their male counterparts. Methods A multicenter prospective cohort of 2364 patients (1365 female and 999 male patients) treated with total SA or reverse total SA from 2007 to 2015 was retrospectively analyzed. Results were assessed using several validated outcome measures and range-of-motion testing. A multivariable analysis identified differences in preoperative values, postoperative values, and preoperative-to-postoperative improvements while adjusting for possible confounders. Results The mean follow-up period was 45.9 ± 23.7 months in female patients and 46.4 ± 23.6 months in male patients. Women underwent SA at a significantly older age (70.8 ± 8.4 years) than men (67.6 ± 8.8 years, P < .01) and began with lower preoperative outcome scores and range-of-motion measurements: American Shoulder and Elbow Surgeons score ( P < .01), Constant score ( P < .01), Simple Shoulder Test score ( P < .01), active abduction ( P < .01), forward flexion ( P < .01), and external rotation ( P = .02). Postoperatively, both groups showed significant improvement. When we evaluated overall improvement from preoperative values, female patients showed increased improvements in the American Shoulder and Elbow Surgeons score ( P = .04) and Simple Shoulder Test score ( P < .01), as well as active forward elevation ( P < .01) and external rotation ( P = .02). However, the difference in improvements did not reach the minimal clinically important difference. Women had a higher incidence of component loosening ( P = .03) and periprosthetic fractures due to falls ( P = .01), whereas men showed a higher incidence of periprosthetic joint infections ( P < .01). Conclusion This study found that female patients undergo SA at an older age and begin with worse shoulder range of motion and outcome scores than male patients. Although women experienced a greater improvement postoperatively in outcome scores and range of motion, this improvement did not reach the minimal clinically important difference. These findings suggest that male and female patients can expect similar improvements in function after undergoing SA; however, the incidence of complications may vary depending on sex.

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Intra-articular injections are a common practice in conservative management of knee osteoarthritis.1 Septic arthritis following these injections is a rare but potentially devastating complication. 2 The culpable microorganisms in the majority of cases are from the Staphylococcus or Streptococcus sp. 3 Septic arthritis of the nonoperated knee joint caused by Cutibacterium (Propionibacterium) acnes is not often expected or encountered. The more common presentation of this pathogen in orthopaedics is an indolent prosthetic joint or spinal infection. We present a rare case of C. acnes septic arthritis of the nonoperated knee, following multiple intra-articular injections. This case demonstrates the subtle presentation of C. acnes septic arthritis and suggests careful consideration of the implications of intraarticular injections in management of knee osteoarthritis. Case ReportA 56-year-old male patient with a medical history of diabetes (HgA1c, 7.5) and obesity (body mass index [BMI], 39.15) presented to a sports medicine clinic complaining of right knee pain and mechanical symptoms. Radiographic and clinical evaluation was consistent with primary osteoarthritis. His symptoms were treated conservatively with physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), sodium hyaluronate injections, and multiple corticosteroid injections. The patient returned a year later with acute exacerbation of chronic knee pain. An aspiration was performed under sterile technique and the analysis demonstrated 68,000 white blood cells (WBCs), 88% polymorphonuclear (PMN) leukocytes, positive uric acid crystals, and negative cultures. Indomethacin and colchicine were initiated to treat gout with transient symptomatic improvement. At 1-week follow-up, the patient presented with recurrent pain accompanied by erythema and swelling. Due to concern for septic arthritis, the patient was admitted to the hospital. Aspiration was attempted and he was initiated on IV vancomycin for cellulitis. Gout treatment was continued and he was discharged on oral antibiotics following significant symptomatic improvement. Keywords► Propionibacterium acnes ► Cutibacterium acnes ► septic arthritis ► intra-articular injection ► steroid injection ► septic knee ► corticosteroid Abstract Cutibacterium (Propionibacterium) acnes, a gram-positive bacillus with low pathogenicity, is an uncommon but known cause of prosthetic joint infections, particularly related to shoulder surgery. C. acnes, however, is an extremely rare pathogen in the nonoperated knee joint. This report details an uncommon case of C. acnes septic knee arthritis after multiple intra-articular steroid injections in a 56-year-old male patient. After an indolent presentation and late diagnosis, the patient underwent surgical debridement with IV antibiotic management. This case illustrates that intra-articular corticosteroid injections for the management of osteoarthritis are not without risk. Literature supporting their use remains limited and clinicians should use proficient clinical judgm...

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