Gabriel Speros, Boin Michael A
Orthopedic Surgery, HCA Research Medical Center, Kansas City, USA.
Orthopedic Surgery, North Kansas City Hospital, Kansas City, USA.
Cureus. 2024 Oct 11;16(10):e71253. doi: 10.7759/cureus.71253. eCollection 2024 Oct.
An 83-year-old male, status one year post-primary right reverse shoulder arthroplasty, presented with clinical and radiographic signs of shoulder instability. The patient subsequently underwent revision reverse shoulder arthroplasty with postoperative cultures growing in all five tissue samples. He was placed on temporary fluconazole since he demanded to leave the hospital during a holiday weekend with plans to get readmitted later. IV amphotericin B was used as induction treatment for two weeks followed by PO voriconazole, which was taken by the patient until eight months postoperatively. He was followed up in the orthopedic clinic status post revision procedure at one and two months and was found to be progressing well. The patient presented to the emergency department eight months after the revision procedure for an unrelated concern that was inconsequential. There were no signs of infection as vital signs and laboratory markers were normal. At 18 months postoperatively, he presented to an outside facility with a left distal femur periprosthetic fracture around a total knee implant, for which open reduction and internal fixation (ORIF) was performed. During this hospital stay, an orthopedic team, known to the authors, evaluated the patient. The right shoulder was stable and without pain, with vitals signs and laboratory markers showing no signs of infection. The patient reported that he continued to be employed as a maintenance worker at a motel. He was discharged soon and is living with current revision shoulder arthroplasty implants.
一名83岁男性,在初次右肩关节反置置换术后一年,出现肩关节不稳定的临床和影像学表现。该患者随后接受了翻修肩关节反置置换术,术后所有五个组织样本的培养物均生长出细菌。由于他在节假日周末要求出院并计划稍后再次入院,因此给他临时使用了氟康唑。静脉注射两性霉素B作为诱导治疗两周,随后口服伏立康唑,患者一直服用至术后八个月。在翻修手术后的1个月和2个月,他在骨科门诊接受随访,发现恢复良好。翻修手术后8个月,患者因一个无关紧要的问题前往急诊科。生命体征和实验室指标正常,没有感染迹象。术后18个月,他因全膝关节置换周围的左股骨远端假体周围骨折前往外部医疗机构就诊,接受了切开复位内固定术(ORIF)。在此次住院期间,作者熟知的一个骨科团队对患者进行了评估。右肩稳定且无疼痛,生命体征和实验室指标均无感染迹象。患者报告称他仍在一家汽车旅馆担任维修工人。他很快出院,目前使用翻修后的肩关节置换植入物生活。