Postoperative deep shoulder infections following rotator cuff repair

Abstract

Rotator cuff repair (RCR) is one of the most commonly performed surgical procedures in orthopaedic surgery. The reported incidence of deep soft-tissue infections after RCR ranges between 0.3% and 1.9%. Deep shoulder infection after RCR appears uncommon, but the actual incidence may be higher as many cases may go unreported. Clinical presentation may include increasing shoulder pain and stiffness, high temperature, local erythema, swelling, warmth, and fibrinous exudate. Generalized fatigue and signs of sepsis may be present in severe cases. Varying clinical presentation coupled with a low index of suspicion may result in delayed diagnosis. Laboratory findings include high erythrocyte sedimentation rate and C-reactive protein level, and, rarely, abnormal peripheral blood leucocyte count. Aspiration of glenohumeral joint synovial fluid with analysis of cell count, gram staining and culture should be performed in all patients suspected with deep shoulder infection after RCR. The most commonly isolated pathogens are Propionibacterium acnes, Staphylococcus epidermidis, and Staphylococcus aureus. Management of a deep soft-tissue infection of the shoulder after RCR involves surgical debridement with lavage and long-term intravenous antibiotic treatment based on the pathogen identified. Although deep shoulder infection after RCR is usually successfully treated, complications of this condition can be devastating. Prolonged course of intravenous antibiotic treatment, extensive soft-tissue destruction and adhesions may result in substantially diminished functional outcomes.

Keywords: Rotator cuff repair, Deep shoulder infection, Shoulder surgery, Postoperative complication

Core tip: Rotator cuff repair (RCR) has become one of the most frequently performed orthopaedic procedures during the last two decades. Paralleling the exponential increase in the number of RCRs, uncommon complications such as postoperative deep shoulder infections may be seen more frequently. Patients who are suspected to have a post-RCR infection require a thorough diagnostic evaluation, including clinical signs and symptoms, laboratory workups and cultures. Although appropriate management of this condition with surgical debridement and lavage, and long-term IV antibiotics usually results in eradication of the infection, complications can be disabling and functional outcomes poor. The majority of the patients with deep infections after RCR report unsatisfactory outcomes with permanent functional limitations.