Prosthetic joint infections in shoulder and elbow: An evaluation of micro-organisms in periprosthetic shoulder and elbow joint infections across the United Kingdom.

Abstract

Prosthetic Joint Infections in Shoulder & Elbow (PRISE) is an epidemiological report of culprit micro-organisms in shoulder and elbow prosthetic joint infection (SE-PJI) across the UK. It also details intra-operative sampling methodology and peri-operative anti-microbial protocols. Retrospective multi-centre review of SE-PJI from 29 UK hospitals was performed. Patients who underwent revision shoulder or elbow arthroplasty between 01/01/2018 and 01/01/2023 with positive intra-operative tissue culture(s) were selected. There were 135 shoulder PJI and 38 elbow PJI. In total, 84% (114) shoulder and 68% (26) elbow PJIs occurred in primary arthroplasties. More than 90% of SE-PJI were diagnosed beyond 2 years after the index procedure. Reverse shoulder arthroplasty (<i>n</i> = 83) and total elbow arthroplasty (<i>n</i> = 27) were the most common shoulder and elbow configurations. Coagulase negative <i>Staphylococcus</i> (CNS), <i>Cutibacterium acnes</i> and methicillin-Sensitive <i>Staphylococcus aureus</i> (MSSA) were grown in majority shoulder PJIs. This was CNS and MSSA for elbow PJI. Teicoplanin with gentamicin was the most used peri-operative anti-microbial protocol (35%). In total, 47% cases (81) followed the Oxford sampling method. Majority of revisions for SE-PJI occurred in primary arthroplasties and were late onset. CNS, <i>C. acnes</i> and MSSA were common in shoulder PJI and CNS and MSSA in elbow PJI. Peri-operative antibiotic protocols and intra-operative sampling methods varied.