Unexpected positive cultures after revision shoulder arthroplasty: does it affect outcome?
Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
Background: Several studies have confirmed a high rate of unexpected positive cultures (UPCs) after presumably aseptic revisions of shoulder arthroplasties; however, the impact on the outcome is still unclear. The purpose of this prospective study is to compare the patient-reported outcomes of standard revisions with and without the emergence of UPCs. Methods: During a 3-year period, we included all patients who were revised for reasons other than suspicion of infection from 2 orthopedic centers. Five biopsies were obtained from every revision, and only cultures with the same bacteria in at least 3 biopsy specimens were classified as UPCs. All patients were assessed using the Oxford Shoulder Score (OSS) and range of motion preoperatively and after at least a 2-year follow-up. Results: In this study, 124 patients were included, with a median follow-up of 29 months (range 29-32), and UPCs emerged after 27 revisions (22%), with Cutibacterium acnes accounting for 67% (18/27). At baseline, the OSS was 22 in both the culture-negative and UPC groups (P =.46). Then, at follow-up, the OSS was 37 in the culture-negative group and 35 in the UPC group (P =.91). The forward elevation increased significantly by 44° and 41°, respectively, in the 2 groups, but no statistically significant difference between the culture-negative group and the UPC group was found (P =.66). In contrast, the external rotation was unchanged after the revision, and again, no difference in the change between the culture-negative and UPC groups (P =.54) was observed. Subgroup analyses stratified by different implant designs revealed equal patterns with no statistical differences in outcome. Conclusion: We did not find a difference in outcome after a presumed aseptic revision regardless of the emergence of UPCs. Similarly, we could not demonstrate that patients with UPCs presented with poorer function at baseline compared with culture-negative patients. The clinical relevance of UPCs thus requires further evaluation, especially in the case of C acnes as a potential pathogenic versus a merely colonizing microbe.
Originalsprog | Engelsk |
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Tidsskrift | Journal of Shoulder and Elbow Surgery |
Vol/bind | 30 |
Udgave nummer | 6 |
Sider (fra-til) | 1299-1308 |
Antal sider | 10 |
ISSN | 1058-2746 |
DOI | |
Status | Udgivet - 2021 |
Bibliografisk note
Funding Information:
The study was funded by a grant from Aarhus University for PhD salary (no grant number).
Publisher Copyright:
© 2021 Journal of Shoulder and Elbow Surgery Board of Trustees
ID: 301439711