Infection after shoulder replacement: A literature review and strategies on diagnosis, management, and clinical outcomes

Infection following shoulder arthroplasty is on the rise as recent data have shown, potentially due to the increase in the number of shoulder arthroplasties being performed. Despite this increase, infective complications in lower limb procedure still exceed those of the upper limb. Infection in the shoulder usually occurs as a low-grade infection due to the most common causative pathogen (Propionibacterium acnes) and can be easily missed. Therefore, a high index of suspicion is needed to make the diagnosis. Furthermore, the use of MSIS criteria can greatly enhance the diagnosis of Periprosthetic Joint Infection (PJI) if appropriately utilised. There are a number of options in the treatment of PJIs; with the 2-stage procedure appearing to be the most commonly utilised, however, the 1-stage has been shown to have similar outcomes, if not superior. The choice of antibiotics should be determined by the antimicrobial susceptibility test and in conjunction with local guidelines and microbiology support. This is usually done as part of the preoperative work up from the pre-surgical aspirate/specimen cultures.