Infections after shoulder surgery are not uncommon. In some cases,
infections can show up even 1-2 years after the initial procedure. Any infection carries risks, and can also jeopardize positive surgery outcomes. So, it is important to understand what causes shoulder surgery infections, and what can be done to minimize risk. We’ve asked renowned orthopedic and shoulder surgeon Dr. Wayne Buz Burkhead to answer a few questions regarding shoulder surgery.
Shoulder Surgery Infections: Q & A
QUESTION: Surgeons and hospitals take extreme care to avoid infections after the shoulder surgery, so how do infections occur?
While everyone is worried about a hospital acquired infection, many surgical site infections arise from bacteria on the patient’s skin or in the hair follicles just beneath the surface. Despite the use of IV antibiotic prophylaxis and skin preparation with antiseptics, some of the bacteria can still survive and colonize the wound. In some instances, bacteria can multiply enough so that a clinical infection does occur. Patients can also have skin and nasal passages colonized by bacteria without even knowing it.
QUESTION: Are shoulders prone to any unique infections?
Shoulders are prone to infection caused by an organism known as Propionibacterium acnes shoulder infection. It is the same organism that causes acne. It is in high concentration on the skin and in the hair follicles around the shoulder, especially in younger male patients.
QUESTION: What special steps do you recommend prior to and after shoulder surgery?
In patients with a history of infections, recent hospitalizations or in a high-risk group, we recommend nasal cultures before surgery. There are rapid screening tests for methicillin-resistant staph, but I prefer a standard culture as well because there are other organisms than Staph that can colonize a patient. Unless that organism is sensitive to the prophylactic antibiotics, it will be unaffected, and the patient will be at higher risk for getting a wound infection. If the patient’s nasal cultures are proven (aka positive for Staph infection), then a course of oral antibiotics and a nasal ointment are applied prior to surgery. In addition, daily skin washes about 5 days prior to surgery are recommended. CLn BodyWash or chlorhexidine or a combination of both can be used. Acne should be cleared up as much as possible and skin preparation with Benzoyl peroxide has been recommended for some high-risk patients.
Postoperatively, the patient should keep the dressing dry and avoid excessive perspiration. While many patients are curious as to what their wound looks like, we prefer that patients turn their heads away from the incision site to avoid breathing on the wound.
QUESTION: Many shoulder surgeries are performed, minimally invasively, arthroscopically. Do these smaller incisions reduce the risk for infection?
QUESTION: What is life like for a patient after a shoulder joint replacement?
Depending on the technique, the patient’s age, and activity level, life can be quite normal. There are many different types of shoulder joint replacement. The conventional shoulder replacement is a metal-ball mated with a plastic socket cemented into the shoulder blade. For the most part, we try to get patients to limit their weightlifting to avoid excessive stress on this complex joint. I have developed techniques that allow even heavy weightlifters to continue to lift weights in which we avoid the plastic socket and reconstruct the socket with a cadaver graft.
Patients who have combined arthritis and massive tears in the rotator cuff require a special type of prosthesis known as a reverse shoulder replacement. This device substitutes for the rotator cuff. It is called a reverse shoulder because the ball is placed where the patient’s socket was, and a socket is placed where the patient’s ball was. This surgery is generally reserved for older patients. But in some special situations such as tumors or severe trauma, we use this device when no other good alternative is available. In other words, shoulders are complex joints, but I am able to solve shoulder issues via numerous replacement methods to return patients to normal activity.
QUESTION: What is life like for a patient after shoulder arthroscopy and no shoulder joint replacement?
The answer to this question depends on the exact condition being treated with shoulder arthroscopy. For a patient with frozen shoulder that is released arthroscopically, no sling is used and the patient is encouraged to move her arm as much as possible immediately after the surgery. A period of immobilization is mandatory after the arthroscopic treatment of rotator cuff tears and a progressive, careful rehabilitation program must be applied. Even though arthroscopic surgery is minimally invasive surgery, it is not pain-free and the overall healing time when tendons are repaired is no different than when more conventional open surgery is performed.
QUESTION: What are signs of an infection in the shoulder joint? What are the best actions to take if infection is suspected?
The signs of infection are shoulder joint pain out of proportion to the time from the surgery, redness, drainage, heat and swelling. Patients will oftentimes have a low-grade fever with infection. If a patient has any of these symptoms following surgery, they need to contact their surgeon immediately or go to an emergency room to be evaluated. Joint infections–once established–are very difficult to completely eradicate, and the risk of systemic involvement (sepsis) is a possibility. So, they are a true medical emergency that must be addressed rapidly.
QUESTION: What can a patient do before and after surgery to minimize risk of infection?
Top tips are maintaining a healthy diet and avoiding areas such as hospitals or gyms where bacteria is found in high concentrations. Cleaning the skin with a cleanser such as CLn BodyWash and antibacterials like chlorhexidine is mandatory prior to surgery. Avoiding situations where skin cuts and abrasions could occur within 10 days of the planned surgery is also recommended. Cutting down or discontinuing alcohol intake will also make the patient’s immune system more responsive. If the patient has a history of infection, he may want to consult an immunologist to see if there is a problem with his immune system, such as an immunoglobulin insufficiency.
We hope you’ve found this Q & A on shoulder surgeries and infection management helpful. Many of the tips are also relevant to any joint surgery, so we encourage you to discuss infection prevention with your surgeon well before your procedure. Subscribe to CLn’s blog (on the right) to have the latest health news and infection tips delivered right to your inbox.
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