COMMENTARY

Prosthetic Shoulder Arthritis Related to Propionibacterium acnes

June 10, 2009

This Viewpoint describes a retrospective review that assessed the importance of Propionibacterium acnes in septic prostheses involving prosthetic shoulder joints.

Propionibacterium acnes Postoperative Shoulder Arthritis: An Emerging Clinical Entity

Levy PY, Fenollar F, Stein A, et al
Clin Infect Dis. 2008;46:1884-1886

Article Summary

This retrospective study was conducted in Marseille, France, from 2005 to 2007. The review assessed the microbiology of infections of prosthetic devices. Specimens were collected by needle aspiration or surgical biopsy, and wound infections were excluded. For verified P acnes, the investigators required cultures of 2 different intraoperative samples.

The study included 179 consecutive patients seen in consultation for infections involving orthopaedic devices. The analyses of 16 infections involving prosthetic shoulders found 9 with P acnes compared with only 1 of 233 infections involving hip or leg prostheses. These data are summarized in the Table.

The authors concluded that P acnes is a newly recognized, relatively common pathogen in infections involving prosthetic shoulder joints.

Viewpoint

P acnes is a relatively hapless skin organism that causes acne and little else, with the possible exception of rare cases of endocarditis and postoperative neurosurgical infections. It is infamous as a contaminant because of its dominance as skin flora. It is easy to be skeptical of any infection involving this organism because it is nearly always a contaminant. However, methods described in this report included recovery from 2 separate needle aspirations or surgical procedures, which would seem to rule out that likelihood. Also, in these 9 cases, there does not appear to be an alternative pathogen for the septic prosthesis.

Abstract

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