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Considerations for Shoulder Joint Replacement after Shoulder Joint Infection

Between 1975 and 2000, a total of 2,568 patients had a shoulder joint replacement (arthroplasty) at the Mayo Clinic in Rochester, Minnesota. In those 25 years, only 13 of those patients had a diagnosis of arthritis from infection, a problem that is much more common in the hip and knee.

Most patients with shoulder infection are treated with antibiotics first. Sometimes, surgery to make the joint smooth is needed. When these treatment options fail, a total joint replacement may be the next step.

There's some concern that re-infection will occur in the new joint. Although this study was small, it showed that shoulder arthroplasty can be done after infection. There's only a small chance of re-infection afterwards. The authors also report that a full rehabilitation program gives better results than a limited program.

Even though the risk of re-infection is low, there are still some possible problems. Damage to the joint from the first infection may leave the patient with bone loss and muscle weakness. Surgical complications such as nerve damage, bleeding, and loosening of the implant are common.

The authors of this study suggest other doctors take several important steps before replacing a shoulder joint after infection. Proper patient selection is the key to success. First, doctors are encouraged to use lab tests to make sure there is no sign of infection in the shoulder. And they should consider using imaging tests to study the condition of the bone and the shape of the joint.

If a stable implant isn't possible, then other forms of treatment are advised. Overall, patients receiving a shoulder arthroplasty after infection don't have the same good results as patients without infection.

References: Joseph Mileti, MD, et al. Shoulder Arthroplasty for the Treatment of Postinfectious Glenohumeral Arthritis. In The Journal of Bone and Joint Surgery. April 2003. Vol. 85-A. No. 4. Pp. 609-614.

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