Accuracy of clinical symptoms and nuclear imaging in the diagnosis of infection in revision shoulder arthroplasty
Background: Prosthetic shoulder infection is the most common reason for revision arthroplasty within 2 years of the index procedure. Due to the preponderance of indolent and slow-growing infection in shoulder arthroplasty, establishing a diagnosis of infection prior to revision shoulder arthroplasty...
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Elsevier
2025-07-01
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| author | Cristina Bassi, MD, FRCSC Diane Nam, MSc, MD, FRCSC Elham Sabri, MSc Darren Drosdowech, MD, FRCSC J.W. Pollock, MSc, MD, FRCSC Dominique Rouleau, MD, FRCSC Taryn Hodgdon, MD, FRCPC Katie McIlquham, HBScHK Jonathan Doyon, MD, FRCSC Peter Lapner, MD, FRCSC |
| author_facet | Cristina Bassi, MD, FRCSC Diane Nam, MSc, MD, FRCSC Elham Sabri, MSc Darren Drosdowech, MD, FRCSC J.W. Pollock, MSc, MD, FRCSC Dominique Rouleau, MD, FRCSC Taryn Hodgdon, MD, FRCPC Katie McIlquham, HBScHK Jonathan Doyon, MD, FRCSC Peter Lapner, MD, FRCSC |
| author_sort | Cristina Bassi, MD, FRCSC |
| collection | DOAJ |
| description | Background: Prosthetic shoulder infection is the most common reason for revision arthroplasty within 2 years of the index procedure. Due to the preponderance of indolent and slow-growing infection in shoulder arthroplasty, establishing a diagnosis of infection prior to revision shoulder arthroplasty can be extremely difficult. The aim of this study was to determine the association between specific clinical symptoms and signs as well as nuclear imaging results with culture positive status in revision shoulder arthroplasty. Methods: This study is a secondary analysis of a multicenter prospective cohort study involving 4 sites and 69 patients who underwent revision shoulder arthroplasty. The cohort was 60% female with a mean age of 64 years (range 36-83 years). Outcomes of interest included preoperative specific clinical symptoms (pain at rest, fevers, chills, and sweats); and white blood cell (WBC) nuclear scan results. At least 5 synovial tissue biopsies from separate regions in the shoulder were obtained intra-operatively during revision surgery. Results: Twenty-three percent of patients (n = 16) had confirmed culture positive infections based on the open biopsies. Sixty-four percent of patients presented with pain at rest. Pain at rest (P = .37), chills (P = .42), and sweats (P = .11) were not associated with infection status. Fever was not reported by any patients in the cohort. There was no association between infection status and erythrocyte sedimentation rate (P = .52), C-reactive protein (0.11), or WBC (P = .34). No patients in the cohort had a positive WBC nuclear scan. Conclusion: This study suggests that specific clinical symptoms including pain at rest, systemic symptoms including fevers, chills, or sweats, and WBC bone scan are poorly associated with the presence of infection in revision shoulder arthroplasty. These findings point to the need for novel testing methods to establish the presence of infection in this patient population. |
| format | Article |
| id | doaj-art-b0432ec979d546dbbd64c4f167c5aa20 |
| institution | Kabale University |
| issn | 2666-6383 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
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| spelling | doaj-art-b0432ec979d546dbbd64c4f167c5aa202025-08-20T03:34:17ZengElsevierJSES International2666-63832025-07-01941228123110.1016/j.jseint.2025.02.005Accuracy of clinical symptoms and nuclear imaging in the diagnosis of infection in revision shoulder arthroplastyCristina Bassi, MD, FRCSC0Diane Nam, MSc, MD, FRCSC1Elham Sabri, MSc2Darren Drosdowech, MD, FRCSC3J.W. Pollock, MSc, MD, FRCSC4Dominique Rouleau, MD, FRCSC5Taryn Hodgdon, MD, FRCPC6Katie McIlquham, HBScHK7Jonathan Doyon, MD, FRCSC8Peter Lapner, MD, FRCSC9Division of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, CanadaDivision of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, CanadaThe Ottawa Methods Centre, Ottawa Hospital Research Institute, Ottawa, ON, CanadaRoth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, London, ON, CanadaDivision of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, CanadaDivision of Orthopaedic Surgery, Hôpital du Sacré-Cœur-de-Montréal, Université de Montréal, Montréal, QC, CanadaDepartment of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, CanadaDivision of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, CanadaDivision of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, CanadaDivision of Orthopaedic Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada; Corresponding author: Peter Lapner, MD, FRCSC, Division of Orthopaedic Surgery, The Ottawa Hospital – General Campus, University of Ottawa, 501 Smyth Road, Box 502, Ottawa, ON K1H 8L6, Canada.Background: Prosthetic shoulder infection is the most common reason for revision arthroplasty within 2 years of the index procedure. Due to the preponderance of indolent and slow-growing infection in shoulder arthroplasty, establishing a diagnosis of infection prior to revision shoulder arthroplasty can be extremely difficult. The aim of this study was to determine the association between specific clinical symptoms and signs as well as nuclear imaging results with culture positive status in revision shoulder arthroplasty. Methods: This study is a secondary analysis of a multicenter prospective cohort study involving 4 sites and 69 patients who underwent revision shoulder arthroplasty. The cohort was 60% female with a mean age of 64 years (range 36-83 years). Outcomes of interest included preoperative specific clinical symptoms (pain at rest, fevers, chills, and sweats); and white blood cell (WBC) nuclear scan results. At least 5 synovial tissue biopsies from separate regions in the shoulder were obtained intra-operatively during revision surgery. Results: Twenty-three percent of patients (n = 16) had confirmed culture positive infections based on the open biopsies. Sixty-four percent of patients presented with pain at rest. Pain at rest (P = .37), chills (P = .42), and sweats (P = .11) were not associated with infection status. Fever was not reported by any patients in the cohort. There was no association between infection status and erythrocyte sedimentation rate (P = .52), C-reactive protein (0.11), or WBC (P = .34). No patients in the cohort had a positive WBC nuclear scan. Conclusion: This study suggests that specific clinical symptoms including pain at rest, systemic symptoms including fevers, chills, or sweats, and WBC bone scan are poorly associated with the presence of infection in revision shoulder arthroplasty. These findings point to the need for novel testing methods to establish the presence of infection in this patient population.http://www.sciencedirect.com/science/article/pii/S2666638325000635Shoulder infectionShoulder arthroplastyProsthetic joint infectionOpen cultureC. acnesRevision |
| spellingShingle | Cristina Bassi, MD, FRCSC Diane Nam, MSc, MD, FRCSC Elham Sabri, MSc Darren Drosdowech, MD, FRCSC J.W. Pollock, MSc, MD, FRCSC Dominique Rouleau, MD, FRCSC Taryn Hodgdon, MD, FRCPC Katie McIlquham, HBScHK Jonathan Doyon, MD, FRCSC Peter Lapner, MD, FRCSC Accuracy of clinical symptoms and nuclear imaging in the diagnosis of infection in revision shoulder arthroplasty JSES International Shoulder infection Shoulder arthroplasty Prosthetic joint infection Open culture C. acnes Revision |
| title | Accuracy of clinical symptoms and nuclear imaging in the diagnosis of infection in revision shoulder arthroplasty |
| title_full | Accuracy of clinical symptoms and nuclear imaging in the diagnosis of infection in revision shoulder arthroplasty |
| title_fullStr | Accuracy of clinical symptoms and nuclear imaging in the diagnosis of infection in revision shoulder arthroplasty |
| title_full_unstemmed | Accuracy of clinical symptoms and nuclear imaging in the diagnosis of infection in revision shoulder arthroplasty |
| title_short | Accuracy of clinical symptoms and nuclear imaging in the diagnosis of infection in revision shoulder arthroplasty |
| title_sort | accuracy of clinical symptoms and nuclear imaging in the diagnosis of infection in revision shoulder arthroplasty |
| topic | Shoulder infection Shoulder arthroplasty Prosthetic joint infection Open culture C. acnes Revision |
| url | http://www.sciencedirect.com/science/article/pii/S2666638325000635 |
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