Assessment of periprosthetic joint infection in revision shoulder arthroplasty

Abstract

Background

In those undergoing revision shoulder arthroplasty, the diagnosis of periprosthetic joint infection (PJI) remains challenging with many clinical and diagnostic variables being considered. The purpose of the study was to evaluate the predictive value of pertinent preoperative and intraoperative factors associated with eventual PJI as determined by the 2018 International Consensus Meeting (ICM) criteria.

Materials and methods

All revision shoulder arthroplasties performed at a single tertiary referral medical center from July 2013 to January 2024 were retrospectively analyzed. Patients were evaluated as definite, probable, possible or unlikely infection according to the 2018 ICM criteria.

Results

Overall, 386 patients underwent revision shoulder arthroplasty, with a mean age of 70 ± 10 years, and 51.3% were female. According to the ICM criteria, 38 patients (9.8%) had definite PJI, 22 had probable PJI (5.7%), 23 had possible PJI (6.0%), and 302 were unlikely to have PJI (78.2%). The majority of patients (n = 71.8%) diagnosed with definitive PJI had 1 major criterion for diagnosis, with all 3 criteria only occurring in 5.1% of these patients. Patients with definite PJI met a mean of 4.6 ± 3.3 minor criteria, and those with probable PJI met a mean of 4.6 ± 2.9 minor criteria. Elevated erythrocyte sedimentation rate (ESR) had the highest positive predictive value (PPV; 75.0%) of preoperative laboratory test values collected, whereas elevated synovial white blood cell count and polymorphonuclear leukocyte percentage each had a PPV of 80%.

Discussion

The majority of revision shoulder arthroplasties are performed for patients who are unlikely to have a PJI, with less than 10% meeting ICM criteria for definite PJI. Most patients meeting criteria for definite PJI met only 1 major criterion, underscoring the importance of minor criteria in diagnosis. Serum ESR and C-reactive proteinCRP had moderate sensitivity and specificity for PJI, and aspiration may still have value in the standard diagnostic workup of shoulder PJI.