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


PJIS presents unique diagnostic and treatment challenges. Prevention is of utmost importance, and there are several measures that the shoulder surgeon may use to accomplish this. Due to the low virulence of the most common causative organisms (C acnes and CNS), evaluation of inflammatory markers and joint aspiration have low sensitivity and are often inconclusive. Novel gene sequencing and molecular analysis techniques are under investigation and in the future may provide a more accurate and timely diagnosis. Anaerobic cultures should be held for a prolonged period, and at least four samples should be obtained. UPCs are not uncommon and present a distinct dilemma. The reported results for one- and two-stage revisions of PJIS have shown equivocal results in terms of infection eradication. Antibiotics play an important part in the management PJIS. Cases with UPCs may not require an adjuvant antibiotic regimen, and more research is needed to determine the clinical relevance of UPCs.