Consider the case of a male athlete who underwent a ream-and-run procedure. His shoulder was stiff right from the beginning. The stiffness in his shoulder did not improve with treatment; the pain increased. He was free of fever, chills and abnormal blood markers.
After two years, he underwent a revision in one stage. The synovial fluid of his patient showed more than 1000 neutrophils. Two frozen sections had over 10 cells per high power field.
Postoperatively, he was placed on oral amoxicillin/clavulanate.
Eight tissue samples after surgery were each positive for low levels Cutibacterium.
Here are a few clinically relevant questions.
(1) Did his pre-revision symptoms of stiffness and discomfort suggest a periprosthetic infected?
(2) Would preoperative aspiration, or an arthroscopic biopsies have changed this case’s management?
(3) Did his findings at surgery indicate a periprosthetic infections?
For this patient, what are the differences between a single-stage and two-stage revision in terms of benefits and risks?
How do the benefits and risks of oral and intravenous antibiotics compare? What are the risks and benefits of oral and intravenous treatment if the organism hasn’t been identified yet?