The Surgical Treatment of Deep Infection in the Native Shoulder Joint

Background: The overall clinical picture surrounding native shoulder infections, and, in particular, the associated long-term functional outcomes of treatment are presently underreported. The purpose of this study is to examine the demographics, diagnostic and treatment strategies, and functional outcomes of isolated shoulder joint sepsis treated with surgical irrigation and debridement (I&D).

Methods: All patients treated with I&D for native shoulder sepsis between 2007 - 2017 were identified. Those without a minimum of one-year follow-up were excluded. Functional outcomes scores, reoperations, and predictors of poor outcome were evaluated.

Results: Twenty-three patients were included in the final study population. Mean age-adjusted CCI score was 4.1 (SD = 3.4, Range = 0 - 10). Twelve patients (52.2%) were treated with open I&D, while 11 patients (47.8%) were treated arthroscopically. Nine patients (39.1%) required multiple I&Ds (mean total number of I&Ds = 1.7, SD = 1.0, Range: 1 - 4). Five patients (21.7%) had at least one documented reinfection after their initial hospitalization, with the initial recurrence of infection occurring 2 - 15 months after the index procedure. Mean ASES score at final follow-up was 55.3 (SD = 26.7, Range: 5.8 - 98.3) and mean SANE score was 53.3 (SD = 30.6, Range: 0 - 100). Stepwise multiple linear regression modeling identified intravenous drug abuse as the most significant predictor for final ASES score [F(1,18) = 6.12, p = .024, adjusted R² = .254].

Conclusion: Following isolated shoulder joint sepsis, infection clearance and acceptable functional outcomes can be achieved using surgical I&D followed by a course of antibiotics, but outcomes are variable.