An uncommon problem with serious consequences
Infection after joint replacement is uncommon. When it does occur, however, it can have serious consequences, and it may require further surgery to resolve. For that reason a good deal of effort goes into prevention, both in the operating theatre and in the weeks beforehand.
Dr Kenneth Cutbush has recorded a discussion of the protocol used each week to reduce infection risk in shoulder replacement procedures, from pre-operative planning through to current practice in theatre.
Why the shoulder is different from the hip and knee
One of the points covered is why infection rates differ between shoulder, hip and knee replacements. The shoulder has a particular feature: the skin around it is rich in sebaceous glands, which are home to Cutibacterium acnes (formerly Propionibacterium acnes), a slow-growing organism that lives normally on and within the skin. Because it sits below the skin surface, it is not fully removed by ordinary surface cleaning, and it is recognised as a frequent organism in shoulder arthroplasty infection in a way that it is not for the hip or knee. Much of the shoulder-specific preparation is directed at reducing this organism's numbers before an incision is made.
How general health affects the risk
Co-existing medical conditions influence infection risk. Diabetes and anaemia are two that are specifically discussed, and both are usually assessed and optimised before a planned joint replacement where there is time to do so. This is one of the reasons the pre-operative consultation covers general health rather than the shoulder alone.
Skin preparation and nasal decolonisation
Two measures are singled out as mattering: nasal decolonisation and skin preparation protocols. Nasal decolonisation addresses bacteria carried in the nose, which is a recognised reservoir for organisms that can reach a surgical wound. Skin preparation in the shoulder is aimed at the deeper, gland-dwelling organisms described above as well as the surface, which is why it may begin at home in the days before surgery rather than only in theatre. We have written separately about one element of this on our post on the benefits of benzoyl peroxide.
What you can do before surgery
The discussion also covers what patients can do themselves. In general terms this means following any washing or nasal preparation instructions exactly as given, reporting any skin breaks, rashes, boils or infections near the shoulder rather than hoping they settle, mentioning any current infection or recent course of antibiotics, keeping diabetes well controlled where relevant, and dealing with outstanding dental treatment before rather than after the operation.
Watch the discussion
The full discussion is available via this link: watch the video.
Further reading
Infection is one of a number of risks worth understanding before deciding on a shoulder replacement. Our surgery FAQs address the common questions, and the anatomic total shoulder replacement and reverse total shoulder replacement pages explain the procedures themselves. To arrange an assessment, see the consultation page.