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HSS Journal ®
Published in: HSS Journal ® 3/2015

01-10-2015 | Original Article

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

Authors: Till O. Klatte, MD, Reza Sabihi, Daniel Guenther, MD, Atul F. Kamath, MD, Johannes M. Rueger, MD, PhD, Thorsten Gehrke, MD, PhD, Daniel Kendoff, MD, PhD

Published in: HSS Journal ® | Issue 3/2015

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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% (p < 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.
Appendix
Available only for authorised users
Literature
1.
Blonna D, Barbasetti N, Banche G, et al. Incidence and risk factors for acute infection after proximal humeral fractures: a multicenter study. J Shoulder Elbow Surg. 2013; 23(4): 528-535.CrossRefPubMed
2.
Bohsali KI, Wirth MA, Rockwood CA Jr. Complication of total shoulder arthroplasty. J Bone Joint Surg Am. 2006; 88-A: 2279-2292.CrossRef
3.
Boileau P, Chuinard C, Roussanne Y, et al. Modified latissimus dorsi and teres major transfer through a single delto-pectoral approach for external rotation deficit of the shoulder: as an isolated procedure or with a reverse arthroplasty. J Shoulder Elbow Surg. 2007; 16(6): 671-682.CrossRefPubMed
4.
Braman JP, Sprague M, Bishop J, et al. The outcome of resection shoulder arthroplasty for recalcitrant shoulder infections. J Shoulder Elbow Surg. 2006; 15: 549-553.CrossRefPubMed
5.
Coste JS, Reig S, Trojani C, et al. The management of infection in arthroplasty of the shoulder. J Bone Joint Surg (Br). 2004; 86(1): 65-69.
6.
Cuff DJ, Virani NA, Levy J, et al. The treatment of deep shoulder infection and glenohumeral instability with debridement, reverse shoulder arthroplasty and postoperative antibiotics. J Bone Joint Surg (Br). 2008; 90(3): 336-342.CrossRef
7.
Horak J, Nilsson BE. Epidemiology of fracture of the upper end of the humerus. Clin Orthop Relat Res. 1975; 112: 250-253.CrossRefPubMed
8.
Jacquot N, Chuinard CH, Boileau P. Results of deep infection after a reverse shoulder arthroplasty. In: Walch G, Boileau P, Mole D, et al., eds. Reverse Shoulder Arthroplasty: Clinical Results, Complications, Revision. France: Sauramps Medical; 2006: 307-312.
9.
Jerosch J, Schneppenheim M. Management of infected shoulder replacement. Arch Orthop Trauma Surg. 2003; 123: 209-214.PubMed
10.
Jost B, Spross C, Grehn H, et al. Locking plate fixation of fractures of the proximal humerus: analysis of complications, revision strategies and outcome. J Shoulder Elbow Surg. 2013; 22(4): 542-549.CrossRefPubMed
11.
Kılıç M, Berth A, Blatter G, et al. Anatomic and reverse shoulder prostheses in fracture sequelae of the humeral head. Acta Orthop Traumatol Turc. 2010; 44(6): 417-425.CrossRefPubMed
12.
Klatte TO, Junghans K, Al-Khateeb H, et al. Single-stage revision for peri-prosthetic shoulder infection: outcomes and results. Bone Joint J. 2013; 95-B(3): 391-395.CrossRefPubMed
13.
Klatte TO, Meinicke R, O’Loughlin P, et al. Incidence of bacterial contamination in primary THA and combined hardware removal: analysis of preoperative aspiration and intraoperative biopsies. J Arthroplasty. 2013; 28(9): 1677-1680.CrossRefPubMed
14.
Klatte TO, O’Loughlin PF, Citak M, et al. 1-stage primary arthroplasty of mechanically failed internally fixated of hip fractures with deep wound infection: good outcome in 16 cases. Acta Orthop. 2013; 84(4): 377-379.PubMedCentralCrossRefPubMed
15.
Klatte TO, Schneider MM, Citak M, et al. Infection rates in patients undergoing primary knee arthroplasty with pre-existing orthopaedic fixation-devices. Knee. 2013; 20(3): 177-180.CrossRefPubMed
16.
Lind T, Kroner K, Jensen J. The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg. 1989; 108: 285-287.CrossRefPubMed
17.
Martinez AA, Bejarano C, Carbonel I, et al. The treatment of proximal humerus nonunions in older patients with reverse shoulder arthroplasty. Injury. 2012; 43(2): 3-6.CrossRef
18.
19.
Parvizi J, Gehrke T, Chen AF. Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J. 2013; 95-B(11): 1450-1452.CrossRefPubMed
20.
Parvizi J, Zmistowski B, Berbari EF, et al. New definition for periprosthetic joint infection. J Arthroplasty. 2011; 26(8): 1136-1138.CrossRef
21.
Raiss P, Edwards TB, da Silva MR, et al. Reverse shoulder arthroplasty for the treatment of nonunions of the surgical neck of the proximal part of the humerus (type-3 fracture sequelae). J Bone Joint Surg Am. 2014; 96(24): 2070-2076.CrossRefPubMed
22.
Seebauer L. Total reverse shoulder arthroplasty: European lessons and future trends. Am J Orthop (Belle Mead NJ). 2007; 36: 22-28.
23.
Wall B, Nové-Josserand L, O’Connor DP, et al. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am. 2007; 89(7): 1476-1485.CrossRefPubMed
Metadata
Title
High Rates of Occult Infection After Shoulder Fracture Fixation: Considerations for Conversion Shoulder Arthroplasty
Authors
Till O. Klatte, MD
Reza Sabihi
Daniel Guenther, MD
Atul F. Kamath, MD
Johannes M. Rueger, MD, PhD
Thorsten Gehrke, MD, PhD
Daniel Kendoff, MD, PhD
Publication date
01-10-2015
Publisher
Springer US
Published in
HSS Journal ® / Issue 3/2015
Print ISSN: 1556-3316
Electronic ISSN: 1556-3324
DOI
https://doi.org/10.1007/s11420-015-9450-z

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