Non-purulent low-grade infection as cause of pain following shoulder surgery: preliminary results

Abstract

Low-grade infection was systematically searched for in all revision shoulder surgeries by harvesting tissue samples. Ten consecutive patients were identified with a non-purulent low-grade infection of the shoulder. All of these patients suffered from pain and eight were stiff. Preoperative aspiration in eight patients yielded bacterial growth in only one case. Serum C-reactive protein levels were normal in seven out of 10 cases. Propionibacterium acnes was identified in seven, coagulase-negative Staphylococcus in two and Staphylococcus saccharolyticus in one case. The delay between harvesting the tissue samples and detection of bacterial growth averaged eight days (range, 2-17). After debridement and antibiotic treatment for a mean of 4.5 months, tissue samples were repeatedly harvested in nine patients due to persistent pain. The infection was microbiologically eradicated in six out of nine cases that had a repeated biopsy. However, nine out of 10 patients continued to suffer from moderate to severe pain. Low-grade infection of the shoulder can be a cause of persistent pain and stiffness. The results of antibiotic treatment are disappointing. Further studies are necessary to analyse this difficult pathology.

Complications infectieuses des prothèses totales inversées d’épaule. À propos d’une série rétrospective, multicentrique de 32 patients réopérés

“…Dans notre série, 6 patients (19%) présentaient un tableau d'épaule raide et douloureuse, peu spécifique, et le diagnostic de certitude reposait alors sur un faisceau d'arguments, comprenant examens complémentaires (biologie, scintigraphie), ponction pré-opératoire, constatations et prélèvements per-opératoires. La sensibilité et la spécificité de la ponction pré-opératoire est contestée dans la littérature (23,(41)(42)(43)(44) , et certains recommandent préférentiellement la réalisation de biopsies synoviales (42,45) à ciel ouvert ou sous arthroscopie. Dans notre série, la ponction identifiait le germe en cause dans 85% des cas.…”

Arthroscopic tissue biopsy for evaluation of infection before revision arthroplasty

“…Pain is the most common presenting symptom. 10,23,28 In the Topolski et al 31 series looking at infection in shoulder arthroplasty, no patient had a draining sinus tract, purulence at the time of surgery, or sepsis. However, 63 of 75 did report increasing pain.…”

“…Several studies have concluded that low-grade infection of the shoulder can result in pain and stiffness. 23,31 In the absence of overt infection, the results of preoperative and intraoperative studies can be equivocal at best. Topolski et al 31 Repeat revision surgery was required in 13% of these shoulders where revision arthroplasty had been performed on the basis of negative preoperative and intraoperative investigations but with positive intraoperative cultures.…”

“…The pain the patient experienced could certainly be attributed to malposition, but several studies have indicated that low-grade infection of the shoulder can cause pain and stiffness. 23,31 Despite negative intraoperative histopathologic tissue assessment, intraoperative cultures positive for P acnes infection were produced from the hemi to total shoulder arthroplasty revision in patient 1. Unfortunately, the diagnosis of deep infection was made after the revision components had been placed.…”

Ostéosynthèse par fixateurs externes d’une fracture bilatérale de clavicule

“…Si ce germe est fréquemment recherché dans les infections postopératoires de l'épaule, il nous semble aussi devoir être suspecté devant l'aspect inhabituellement inflammatoire d'une zone fracturaire au niveau de la ceinture scapulaire [17][18][19][20][21]. Une mise en culture prolongée de deux à trois semaines du fait d'une croissance très lente de cette bactérie est toujours néces-saire [22].…”