Analysis of Six Cases Attached to Postoperative Infection after Shoulder Arthroscopic Rotator Cuff Repair: A Case Report
DOI:
https://doi.org/10.53469/jcmp.2024.06(10).25Keywords:
Rotator cuff injury, Shoulder arthroscopy, Rotator cuff repair, Postoperative infection, Retrospective analysisAbstract
Background: The purpose of this case report was to investigate the incidence of departmental infections following arthroscopic rotator cuff repair over a three-year period as well as to compare the clinical efficacy of treating postoperative infections following rotator cuff repair using incisional debridement sutures, arthroscopic shoulder debridement and lavage treatment, and arthroscopic debridement and lavage in combination with antibiotic-cement beading. Case presentation: A retrospective evaluation of 600 shoulder arthroscopic rotator cuff repairs performed in our hospital between 2021.1 and 2023.12 was conducted to screen the data of six Chinese women aged 51-71 years, who completed routine hematological and radiological examinations after admission, were treated with antibiotics, and the use of antibiotics was adjusted according to the results of wound secretion culture. Among them, 2 cases were treated with arthroscopic debridement and irrigation of the shoulder, 2 cases were treated with arthroscopic debridement and irrigation of the shoulder combined with antibiotic cemented nails, 1 case was treated with incision and debridement and suture, and 1 case was treated conservatively. Postoperative anti-infective treatment with antibiotics was continued, and the relevant indexes were rechecked. Preoperative and postoperative follow-up were performed using the visual analog scale (VAS) and the American Shoulder and Elbow Surgeons (ASES) score. Results: The infection rate of patients who underwent rotator cuff repair during the evaluation period was 1%. Culture of wound secretions from six infected patients showed culture results of Staphylococcus aureus, Serratia marcescens, Mycobacterium xylosoxidans colorless, and Mycobacterium tuberculosis, with no obvious abnormalities, and no cultures were performed. Two cases were treated with shoulder arthroscopic debridement and irrigation, two cases were treated with shoulder arthroscopic debridement and irrigation combined with antibiotic bone cement beading, one case was treated with incision and debridement and suturing, and one case was treated conservatively. At the final follow-up, the scores of two patients treated with arthroscopic debridement and irrigation of the shoulder improved, two patients treated with arthroscopic debridement and irrigation of the shoulder combined with antibiotic-cemented beading did not show significant improvement, one patient treated with incisional debridement and suturing improved significantly, and one patient treated conservatively improved significantly. Conclusion: The overall infection rate of arthroscopic rotator cuff repair of the shoulder over 3 years was 1% (6/600). The use of incisional debridement and suturing or shoulder arthroscopic debridement and irrigation has better clinical outcomes than shoulder arthroscopic debridement and irrigation combined with cement beading for the treatment of infection after arthroscopic rotator cuff repair.
References
Brislin KJ, Field LD, Savoie FH 3rd. Complications after ar⁃throscopic rotator cuff repair[J]. Arthroscopy, 2007, 23(2): 124 ⁃128. doi:10.1016/j.arthro. 2006. 09. 001.
Daffner SD, Beimesch CF, Wang JC. Geographic and demographic variability of cost and surgical treatment of idiopathic scoliosis[J]. Spine (Phila Pa 1976), 2010, 35(11): 1165 ⁃ 1169. doi:10.1097/BRS. 0b013e3181d88e78.
Garrigues GE, Zmistowski B, Cooper AM, Green A; ICM Shoulder Group. Proceedings from the 2018 International Consensus Meeting on Orthopedic Infections: management of periprosthetic shoulder infection. J Shoulder Elbow Surg. 2019 Jun; 28(6S): S67-S99. doi: 10.1016/j.jse.2019.04.015.
Gombera MM, Kahlenberg CA, Nair R, Saltzman MD, Terry MA. All-arthroscopic suprapectoral versus open subpectoral tenodesis of the long head of the biceps brachii. Am J Sports Med. 2015 May;43(5):1077-83.doi: 10.1177/0363546515570024.
Herrera MF, Bauer G, Reynolds F, Wilk RM, Bigliani LU, Levine WN. Infection after mini-open rotator cuff repair. J Shoulder Elbow Surg. 2002 Nov-Dec; 11(6): 605-8. doi: 10.1067/mse.2002.127302.
Hudek R, Sommer F, Kerwat M, Abdelkawi AF, Loos F, Gohlke F. Propionibacterium acnes in shoulder surgery: true infection, contamination, or commensal of the deep tissue? J Shoulder Elbow Surg. 2014 Dec; 23(12): 1763-1771. doi: 10.1016/j.jse.2014.05.024.
Jain NB, Higgins LD, Losina E, Collins J, Blazar PE, Katz JN. Epidemiology of musculoskeletal upper extremity ambulatory surgery in the United States. BMC Musculoskelet Disord. 2014 Jan 8;15:4. doi: 10.1186/ 1471-2474-15-4.
Jensen AR, Cha PS, Devana SK, Ishmael C, Di Pauli von Treuheim T, D'Oro A, Wang JC, McAllister DR, Petrigliano FA. Evaluation of the Trends, Concomitant Procedures, and Complications With Open and Arthroscopic Rotator Cuff Repairs in the Medicare Population. Orthop J Sports Med. 2017 Oct 12; 5(10): 2325967117731310. doi: 10.1177/2325967117731310.
Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods[J]. Pain, 1986, 27(1): 117⁃126. doi: 10.1016/0304⁃3959(86) 90228⁃9.
Johnson LL, Shneider DA, Austin MD, Goodman FG, Bullock JM, DeBruin JA (1982) Two per cent glutaraldehyde: a disinfect-ant in arthroscopy and arthroscopic surgery. J Bone Joint Surg Am 64:237–239.
Kasten P, Keil C, Grieser T, Raiss P, Streich N, Loew M. Prospective randomised comparison of arthroscopic versus mini-open rotator cuff repair of the supraspinatus tendon. Int Orthop. 2011 Nov;35(11):1663-70. doi: 10.1007/s00264-011-1262-2.
Kunutsor SK, Beswick AD, Whitehouse MR, Wylde V, Blom AW. Debridement, antibiotics and implant retention for periprosthetic joint infections: A systematic review and meta-analysis of treatment outcomes. J Infect. 2018 Dec;77(6):479-488. doi: 10.1016/j.jinf.2018.08. 017.
Kwon YW, Kalainov DM, Rose HA, Bisson LJ, Weiland AJ. Management of early deep infection after rotator cuff repair surgery. J Shoulder Elbow Surg. 2005 Jan-Feb;14(1):1-5. doi: 10.1016/j.jse.2004.04.010.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999 Apr; 27(2): 97-132; quiz 133-4; discussion 96.doi: 10.1086/501620.
Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee[J]. Infect Control Hosp Epidemiol,1999, 20(4): 250⁃278; quiz 279⁃280. doi: 10.1086/501620.
Marcheggiani Muccioli GM, Guerra E, Roberti di Sarsina T, Alesi D, Fratini S, Cammisa E, Rinaldi VG, Lullini G, Rotini R, Zaffagnini S. Diagnosis and Treatment of Infected Shoulder Arthroplasty: Current Concepts Review. Joints. 2018 Dec 10;6(3):173-176. doi: 10.1055/s-0038-1675800.
McFarland EG, O’Neill OR, Hsu CY (1997) Complications of shoulder arthroscopy. J South Orthop Assoc 6:190-196.
Millar NL, Wu X, Tantau R, Silverstone E, Murrell GA. Open versus two forms of arthroscopic rotator cuff repair. Clin Orthop Relat Res. 2009 Apr;467(4):966-78. doi: 10.1007/s11999-009-0706-0.
Mirzayan R, Itamura JM, Vangsness CT Jr, Holtom PD, Sherman R, Patzakis MJ. Management of chronic deep infection following rotator cuff repair. J Bone Joint Surg Am. 2000 Aug;82(8):1115-21. doi: 10.2106/ 00004623-200008000-00008.
Patel A, Calfee RP, Plante M, Fischer SA, Green A. Propionibacterium acnes colonization of the human shoulder. J Shoulder Elbow Surg. 2009 Nov-Dec; 18(6):897-902. doi: 10.1016/j.jse.2009.01.023.
Paxton ES, Green A, and Krueger VS. Periprosthetic infections of the shoulder: diagnosis and management[J]. J Am Acad Orthop Surg,2019, 27(21): e935⁃e944. doi: 10.5435/JAAOS⁃D⁃18⁃00232.
Pottinger P, Butler-Wu S, Neradilek MB, Merritt A, Bertelsen A, Jette JL, Warme WJ, Matsen FA 3rd. Prognostic factors for bacterial cultures positive for Propionibacterium acnes and other organisms in a large series of revision shoulder arthroplasties performed for stiffness, pain, or loosening. J Bone Joint Surg Am. 2012 Nov 21;94(22):2075-83. doi: 10.2106/JBJS.K.00861.
Randelli P, Castagna A, Cabitza F, Cabitza P, Arrigoni P, Denti M. Infectious and thromboembolic complications of arthroscopic shoulder surgery. J Shoulder Elbow Surg. 2010 Jan;19(1):97-101. doi: 10.1016/j.jse.2009.04.009.
Richards RR, An KN, Bigliani LU, Friedman RJ, Gartsman GM, Gristina AG, Iannotti JP, Mow VC, Sidles JA, Zuckerman JD. A standardized method for the assessment of shoulder function. J Shoulder Elbow Surg. 1994 Nov; 3(6): 347-52. doi: 10.1016/ S1058-2746 (09)80019-0.
Settecerri JJ, Pitner MA, Rock MG, Hanssen AD, Cofield RH. Infection after rotator cuff repair. J Shoulder Elbow Surg. 1999 Jan-Feb;8(1): 1-5.doi: 10.1016/s1058-2746(99)90045-9.
Vopat BG, Lee BJ, DeStefano S, Waryasz GR, Kane PM, Gallacher SE, Fava J, Green AG. Risk Factors for Infection After Rotator Cuff Repair. Arthroscopy. 2016 Mar;32(3):428-34. doi: 10.1016/j.arthro.2015.08.021.
Weber SC, Abrams JS, Nottage WM. Complications associated with arthroscopic shoulder surgery. Arthroscopy. 2002 Feb;18(2 Suppl 1): 88-95. doi: 10.1053/jars.2002.31801.
Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, Kobayashi T. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg. 2010 Jan; 19(1): 116-20.doi: 10.1016/j.jse.2009.04.006.
Yeranosian MG, Arshi A, Terrell RD, Wang JC, McAllister DR, Petrigliano FA. Incidence of acute postoperative infections requiring reoperation after arthroscopic shoulder surgery. Am J Sports Med. 2014 Feb; 42(2): 437-41. doi: 10.1177/0363546513510686.
Zimmerli W, Trampuz A, Ochsner PE. Prosthetic⁃joint infections[J]. N Engl J Med, 2004, 351(16): 1645 ⁃ 1654. doi: 10.1056/NEJMra040181.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Rui Wang, Kaiwei Zhang, Yingying Tan
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
