Periprosthetic Infections of the Shoulder

Diagnosis and Management

E. Scott Paxton, MD; Andrew Green, MD; Van S. Krueger, MD, MBA


J Am Acad Orthop Surg. 2019;27(21):e935-e944. 

In This Article

Clinical Presentation

The clinical presentation is variable and dependent on the timing of the presentation, virulence of the pathogen(s), and host response. The presentation can be classified as acute (less than 3 months after the primary surgery), subacute (between 3 and 12 months), and chronic (greater than a year).[8]

The acute presentation is usually accompanied by the typical signs of infection including pain, swelling, erythema, drainage, and fever. Acute postoperative infections are generally the result of direct inoculation during the initial procedure.C acnes and other more virulent pathogens (eg, S aureus, gram-negative rods, Streptococcus species) are usually isolated in the cultures.

Subacute and chronic infections are more commonly the result of lower virulence, nonsuppurative bacteria, such as C acnes or CNS. In these cases, the typical clinical signs of infection are often absent. Instead, these patients often present with some combination of pain and stiffness. With most cases caused by low-virulent organisms, clinicians must maintain a high index of suspicion when evaluating patients with pain, limited motion, and dysfunction after shoulder arthroplasty.