Authors: George S. Athwal, MD, FRCSC, John W. Sperling, MD*, Damian M. Rispoli, MD, Robert H. Cofield, MD
Title: Deep Infection after Rotator Cuff Repair
Addresses: Department of Orthopedic Surgery, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905
Purpose: The purpose of this study was to review the incidence, clinical presentation, bacteriology, treatment, and outcomes of patients with rotator cuff repair complicated with deep infection.
Methods: Between 1975 and 2003, thirty-nine cases of deep infection following rotator cuff repair were identified in thirty-eight patients. The medical records, laboratory data and radiographs were retrospectively examined. The mean age of the patients at the time of infection diagnosis was 61 years (range, 33 to 82 years) and the mean interval from rotator cuff repair to the time of infection diagnosis was 49 days. At a final follow-up of 8.2 years (range, 30 months to 19.8 years), seven patients had died and two patients had been lost to follow-up leaving twenty-nine cases for outcome evaluation.
Results: The incidence of deep infection after rotator cuff repairs that were performed at our institution was 0.43% (21 of 4886 cases). Erythrocyte sedimentation rate and C-reactive protein were elevated in only 60% and 50% of patients, respectively. Propionibacterium acnes was the most common organism isolated, infecting 20 of 39 cases (51%). A mean of 3.3 surgical debridements were necessary for the eradication of infection. At a mean of 8.2 years final follow-up, mean active abduction was 121° and mean external rotation was 44°. The ASES score averaged 67 points (range, 5 to 100 points) and the Simple Shoulder Test score averaged 7.3 points (range, 1 to 12 points).
Discussion: The data from this study suggests that the eradication of deep infection following rotator cuff repair is possible, however, substantial functional limitations are not unusual. Additionally, the treating surgeon should be aware of the high incidence of Propionibacterium and the importance of allowing a minimum of seven days of culture to identify this organism.