Clinical Characteristics and Long-term Outcomes After Septic Arthritis of the Native Glenohumeral Joint: A 20-Year Retrospective Review.

Document Type

Article

Publication Date

1-1-2019

Publication Title

Orthopedics

Keywords

Adult, Aged, Aged, 80 and over, Arthritis, Infectious, Arthroplasty, Replacement, Shoulder, Bacterial Infections, Female, Humans, Male, Middle Aged, Postoperative Complications, Reoperation, Retrospective Studies, Risk Factors, Shoulder Joint, Synovial Fluid, Treatment Outcome

Abstract

Septic arthritis of the native glenohumeral joint is rare, and there is little information available regarding the natural progression and long-term joint outcomes of this pathology. The authors performed a retrospective analysis of 97 patients with culture-positive glenohumeral septic arthritis between 1995 and 2015 at their institution with a mean clinical follow-up of 83.1 months. Patient records were reviewed to document demographic and laboratory data, clinical presentation, postoperative complications, recurrences, and subsequent shoulder arthroplasty. Common comorbidities uncovered included 20 immunocompromised patients (20.6%), intravenous drug use among 27 patients (27.8%), diabetes mellitus among 40 patients (41.2%), and 18 patients (18.5%) receiving hemodialysis. Staphylococcus aureus was the most common pathogen identified (61 patients; 62.8%), followed by streptococcal species (17 patients; 17.2%). Hematogenous spread of infection was the most common etiology of shoulder sepsis (40.2%). Seven patients (7.2%) developed shoulder sepsis of undetermined etiology in the absence of established risk factors, and 16 patients (16.4%) developed recurrent glenohumeral septic arthritis at a mean of 40 months following initial eradication of infection. Three patients (3.0%) eventually underwent same-side shoulder arthroplasty at a mean of 18 months following septic arthritis, with none experiencing a periprosthetic joint infection. Glenohumeral septic arthritis is highly unlikely in the absence of medical risk factors. Long-term recurrence after clinically successful treatment is low (16.5%), and few patients undergo elective arthroplasty following shoulder septic arthritis. However, orthopedic surgeons can expect 30% to 40% of patients to require multiple trips to the operating room to successfully treat the initial joint infection, regardless of treatment method. [Orthopedics. 2019; 42(1):e118-e123.].

Medical Subject Headings

Adult; Aged; Aged, 80 and over; Arthritis, Infectious; Arthroplasty, Replacement, Shoulder; Bacterial Infections; Female; Humans; Male; Middle Aged; Postoperative Complications; Reoperation; Retrospective Studies; Risk Factors; Shoulder Joint; Synovial Fluid; Treatment Outcome

PubMed ID

30602050

Volume

42

Issue

1

First Page

e118

Last Page

e123

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