Optimizing Outcomes in Shoulder Arthroplasty: Mitigating Surgical Complications in High-Risk Patients – Case Report

The risk of a periprosthetic joint infection after arthroplasty can be devastating to a patient, with the possibility of loss of limb or even death. There are multiple tools at the surgeon’s disposal to help minimize the risk of a complication occurring, and we present a novel intra-operative sterilization technique that has the potential to further minimize these unwanted outcomes. A 60-year-old right hand dominant male who had previously undergone two attempted rotator cuff spearing surgeries on his right shoulder now presents with continued right shoulder pain and evidence of rotator cuff arthropathy on imaging. He wished to proceed with a reverse total shoulder arthroplasty (rTSA). Due to his multiple surgeries on this shoulder as well as his medical comorbidities, we were concerned with his elevated risk for intra-operative complications, blood loss and hematoma formation, as well as risk for a periprosthetic joint infection. We present our technique for minimizing the risk of these undesirable outcomes, one of which is a novel intra-operative sterilization technique with sterile betadine being used in the surgical wound. Our technique to optimize the patient preoperatively, minimize periprosthetic joint infection, and maintain adequate hemostasis throughout the surgery can be utilized to help surgeons minimize the risk of sustaining these unwanted outcomes.