Author(s): Emilie V. Cheung, MD*, John W. Sperling, MD, Robert H. Cofield, MD, Stanford University, Stanford, CA and Mayo Clinic, Rochester, MN
Title: Infection Associated with Hematoma Formation After Shoulder Arthroplasty
Purpose: The significance of hematoma formation and its relationship to infection after shoulder arthroplasty has not been previously described. The purpose of this study is to report the results of treatment of hematomas after shoulder arthroplasty.
Methods: Between 1978 and 2006, there were 4,147 shoulder arthroplasties performed at this institution. Of these, there were thirteen shoulders that underwent re-operation due to hematoma formation following shoulder arthroplasty. There were 8 cases of hemiarthroplasty and 5 cases of total shoulder arthroplasty. The indication for the index shoulder arthroplasty was osteoarthritis in 5, rotator cuff arthropathy in 3, rheumatoid arthritis is 2, acute fracture in 1, nonunion in 1, and neoplasm in 1. The mean time interval from the index arthroplasty to surgical treatment of the hematoma was 7 days (range, 0.5 to 31 days).
Results: Among nine cases where cultures were taken, there were seven positive cultures. Organisms identified were: Propionibacter acnes in 4, Staphylococcus epidermidis in 1, Streptococcus species in 1, and Staphylococcus epidermidis with Peptostreptococcus in 1. Two of the thirteen cases eventually underwent resection arthroplasty for deep infection. The Neer score was excellent in 1, satisfactory in 6, and unsatisfactory in 6 cases. The reason for an unsatisfactory result was due to resection arthroplasty for deep infection in 2 cases and lack of motion in 4 cases.
Discussion: The data from this study suggest that hematoma formation after shoulder arthroplasty is often accompanied by positive intraoperative cultures. The surgeon should be aware of the high rate of unsatisfactory results associated with this complication as well as the possibility of developing a deep infection requiring additional surgery.