In Tokyo
Speaking at the Japanese Shoulder Society in October 2017, on "How to Prevent Infection in Shoulder Arthroplasty".
What shoulder arthroplasty is
Arthroplasty is the medical term for joint replacement. In the shoulder it means replacing the worn surfaces of the ball and socket joint with artificial components, and it is considered when arthritis or damage to the joint surface is causing pain and loss of movement that has not responded to non-operative measures. There are two broad forms. An anatomic total shoulder replacement reproduces the normal arrangement, with a ball on the upper arm bone and a socket on the shoulder blade, and relies on the rotator cuff tendons still working. A reverse total shoulder replacement swaps that arrangement around, placing the ball on the shoulder blade and the socket on the arm, which allows the deltoid muscle to lift the arm when the rotator cuff is no longer intact.
Which of these is appropriate, and whether replacement is appropriate at all, depends on the individual patient's examination findings, imaging and general health. Individual results vary.
Why infection prevention is given so much attention
Infection around an implanted joint is uncommon but it is one of the more serious problems that can follow any joint replacement, because bacteria can persist on the surface of an implant where they are difficult to clear with antibiotics alone. Treating an established infection may require further surgery, so the effort is concentrated on preventing it in the first place.
Prevention is not a single measure but a sequence of them, running from assessment and preparation of the patient before the operation, through skin preparation, antibiotic timing, theatre discipline and handling of the implant during the procedure, to wound care afterwards. The shoulder has particular interest here because the skin of the shoulder and armpit region carries organisms that are slow growing and were historically easy to overlook. Standardising each step so that it is done the same way every time is the practical aim, and that is the kind of subject a scientific meeting is well suited to examining. Individual results vary.
Related information
- Our post on preventing infection in shoulder replacement surgery, written for patients
- Our post on the JSS 2017 meeting
- Anatomic total shoulder replacement
- Reverse total shoulder replacement