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Single-Stage Revision Is Effective for Failed Shoulder Arthroplasty with Positive Cultures for Propionibacterium

Hsu, Jason E. MD; Gorbaty, Jacob D. MD; Whitney, Ian J. MD; Matsen, Frederick A. III MD

Journal of Bone & Joint Surgery - American Volume: 21 December 2016 - Volume 98 - Issue 24 - p 2047–2051
doi: 10.2106/JBJS.16.00149
Scientific Articles

Background: Revision shoulder arthroplasties are often culture-positive for Propionibacterium. This study tests the hypothesis that the functional outcomes of revising Propionibacterium culture-positive failed arthroplasties with a single-stage revision and immediate antibiotic therapy are not inferior to the clinical outcomes of revising failed shoulder arthroplasties that are not culture-positive.

Methods: Fifty-five shoulders without obvious clinical evidence of infection had a single-stage revision arthroplasty. The patient self-assessed functional outcomes for shoulders with ≥2 positive cultures for Propionibacterium (the culture-positive group) were compared with shoulders with no positive cultures or only 1 positive culture (the control group).

Results: The culture-positive group had 89% male patients, with a mean age (and standard deviation) of 63.5 ± 7.2 years. The mean Simple Shoulder Test (SST) scores for the 27 culture-positive shoulders improved from 3.2 ± 2.8 points before the surgical procedure to 7.8 ± 3.3 points at a mean follow-up of 45.8 ± 11.7 months after the surgical procedure (p < 0.001), a mean improvement of 49% of the maximum possible improvement. The control group had 39% male patients, with a mean age of 67.1 ± 8.1 years. The mean SST scores for the 28 control shoulders improved from 2.6 ± 1.9 points preoperatively to 6.1 ± 3.4 points postoperatively at a mean follow-up of 49.6 ± 11.8 months (p < 0.001), a mean improvement of 37% of the maximum possible improvement. Subsequent procedures for persistent pain or stiffness were required in 3 patients (11%) in the culture-positive group and in 3 patients (11%) in the control group; none of the revisions were culture-positive. Fourteen patients reported side effects to antibiotics.

Conclusions: Clinical outcomes after single-stage revision for Propionibacterium culture-positive shoulders were at least as good as the outcomes in revision procedures for control shoulders. Two-stage revision procedures may not be necessary in the management of these cases. Patients should be educated with regard to potential antibiotic side effects.

Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

1Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington

2University of Washington School of Medicine, Seattle, Washington

3South Texas Regional Medical Center, Jourdanton, Texas

E-mail address for J.E. Hsu: jehsu@uw.edu

E-mail address for J. Gorbaty: jgorbaty@uw.edu

E-mail address for I.J. Whitney: ianj128@gmail.com

E-mail address for F.A. Matsen III: matsen@uw.edu

Copyright 2016 by The Journal of Bone and Joint Surgery, Incorporated
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