Assessment of Periprosthetic Joint Infection in Revision Shoulder Arthroplasty.

Abstract

Introduction: 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 & methods: All revision shoulder arthroplasties performed at a single tertiary referral medical center from July 2013 and 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 and51.3% 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 one major criteria 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 ESR had the highest PPV (75.0%) of preoperative lab values collected, while elevated synovial white count and PMN% each had a PPV of 80%.

Discussion: The majority of revisions 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 criteria, underscoring the importance of minor criteria in diagnosis. Serum ESR and CRP had moderate sensitivity and specificity for PJI, and aspiration may still have value in the standard diagnostic workup of shoulder PJI.