Lucas Robert M, Hsu Jason E, Whitney Ian J, Wasserburger Jory, Matsen Frederick A
Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, USA.
University of Washington School of Medicine, Seattle, WA, USA.
J Shoulder Elbow Surg. 2016 Aug;25(8):1371-5. doi: 10.1016/j.jse.2015.12.026. Epub 2016 Mar 3.
Glenoid loosening is one of the most common causes of total shoulder failure. High rates of positive cultures of Propionibacterium and coagulase-negative staphylococcus have been found among shoulders having surgical revision for glenoid loosening. This study reviewed the culture results in a series of surgical revisions for failed total shoulder arthroplasty to determine the relationship between glenoid loosening and positive cultures.
The medical records of 221 patients without obvious evidence of infection who underwent revision total shoulder arthroplasty were reviewed to examine the association between the security of fixation of the glenoid component and the results of cultures obtained at revision surgery.
Of the revised shoulders, 53% had positive cultures; 153 of the shoulders (69%) had a loose glenoid component, whereas 68 (31%) had secure glenoid component fixation. Of the 153 loose glenoid components, 82 (54%) had at least 1 positive culture and 44 (29%) had 2 or more positive cultures of the same microorganism. Similarly, of the 68 secure glenoid components, 35 (51%) had at least 1 positive culture (P = .77) and 14 (21%) had 2 or more positive cultures of the same microorganism (P = .25). Explanted glenoid components that were loose had a higher rate of culture positivity (56% [24/43]) in comparison to explanted glenoid components that were well fixed (13% [1/8]) (P = .05).
Propionibacterium and coagulase-negative staphylococcus are commonly recovered in revision shoulder arthroplasty, whether or not the glenoid components are loose.
肩胛盂松动是全肩关节置换失败最常见的原因之一。在因肩胛盂松动而进行手术翻修的肩关节中，已发现丙酸杆菌和凝固酶阴性葡萄球菌的阳性培养率很高。本研究回顾了一系列全肩关节置换失败后的手术翻修培养结果，以确定肩胛盂松动与阳性培养之间的关系。
回顾了221例无明显感染证据且接受翻修全肩关节置换术患者的病历，以检查肩胛盂假体固定的安全性与翻修手术时获得的培养结果之间的关联。
在翻修的肩关节中，53%培养结果呈阳性；153个肩关节（69%）的肩胛盂假体松动，而68个（31%）的肩胛盂假体固定牢固。在153个松动的肩胛盂假体中，82个（54%）至少有1次阳性培养，44个（29%）有2次或更多次相同微生物的阳性培养。同样，在68个固定牢固的肩胛盂假体中，35个（51%）至少有1次阳性培养（P = 0.77），14个（21%）有2次或更多次相同微生物的阳性培养（P = 0.25）。与固定良好的取出肩胛盂假体（13% [1/8]）相比，松动的取出肩胛盂假体培养阳性率更高（56% [24/43]）（P = 0.05）。
无论肩胛盂假体是否松动，在翻修肩关节置换术中常见丙酸杆菌和凝固酶阴性葡萄球菌。
