Shoulder-Joint Infection: Diagnosis and Management

The best way to address sepsis is obviously to avoid it. When, however, it does occur, early suspicion, diagnosis, recognition, and rapid management represent the guiding principles of avoiding disaster. The presence of warmth, redness, pain, fever, and loss of mobility are hallmarks of infection in the shoulder, as in other joints. Early detection through sterile aspiration and culture, laboratory testing, imaging, careful physical evaluation and a high index of suspicion will allow for rapid management. Particularly troublesome pathogens include methicillin-resistant Staphylococcus aureus, Staphylococcus epidermidis, and Propionibacterium acnes. These organisms may require prolonged (15-day) laboratory incubation to detect. Early on, aggressive irrigation and debridement either arthroscopically or by formal arthrotomy with removal of all potentially infected or nonviable tissue can allow salvage. In more advanced cases, staged exchange arthroplasty has proven to be an effective technique for salvage management. This, combined with extended intravenous antibiotics, allows secondary revision arthroplasty with antibiotic impregnated cement once all indicators suggest that the patient is free of infection. This technique has proven effective in our hands and has been duplicated by others providing reasonable function below the horizontal with elevation ranging from 70 to 120° and excellent pain relief.