This review covers periprosthetic joint infection after anatomical and reverse total shoulder arthroplasty. It walks through risk factors, causative organisms, diagnostic workup, and the range of surgical treatment options. The emphasis is on why shoulder infections, especially P. acnes, are uniquely hard to diagnose and manage.
When you evaluate a painful shoulder arthroplasty, remember that normal inflammatory markers do not exclude infection. P. Acnes is the reason. It is low-virulence, lives deep in pilosebaceous follicles, and grows slowly, so a workup that looks reassuring can still hide infection. Always ask the lab to hold cultures well beyond the standard 3-5 days.
Use markers in combination rather than alone. IL-6 has the best accuracy, but CRP, ESR, and synovial aspirate together give the strongest picture. A sinus tract to the prosthesis is the most specific clinical sign.
For treatment, the evidence is genuinely contested. The literature leans toward single-stage revision for acute infections and 2-stage for chronic, but head-to-head data conflict. Irrigation and debridement alone is a weak option, succeeding under half the time.
Prevention is where you have the most leverage: vancomycin plus cefazolin prophylaxis, ChloraPrep skin prep, and topical benzoyl peroxide to knock down P. Acnes.
This review covers periprosthetic joint infection after anatomical and reverse total shoulder arthroplasty. It walks through risk factors, causative organisms, diagnostic workup, and the range of surgical treatment options. The emphasis is on why shoulder infections, especially P. acnes, are uniquely hard to diagnose and manage.
When you evaluate a painful shoulder arthroplasty, remember that normal inflammatory markers do not exclude infection. P. Acnes is the reason. It is low-virulence, lives deep in pilosebaceous follicles, and grows slowly, so a workup that looks reassuring can still hide infection. Always ask the lab to hold cultures well beyond the standard 3-5 days.
Use markers in combination rather than alone. IL-6 has the best accuracy, but CRP, ESR, and synovial aspirate together give the strongest picture. A sinus tract to the prosthesis is the most specific clinical sign.
For treatment, the evidence is genuinely contested. The literature leans toward single-stage revision for acute infections and 2-stage for chronic, but head-to-head data conflict. Irrigation and debridement alone is a weak option, succeeding under half the time.
Prevention is where you have the most leverage: vancomycin plus cefazolin prophylaxis, ChloraPrep skin prep, and topical benzoyl peroxide to knock down P. Acnes.