The Surgical Treatment of Deep Infection in the Native Shoulder Joint

The overall clinical picture surrounding native shoulder infections, and, in particular, the associatedlong-term functional outcomes of treatment are presently underreported. The purpose of this study is to examine thedemographics, diagnostic and treatment strategies, and functional outcomes of isolated shoulder joint sepsis treatedwith surgical irrigation and debridement (I&D). All patients treated with I&D for native shoulder sepsis between 2007 – 2017 were identified. Those withouta minimum of one-year follow-up were excluded. Functional outcomes scores, reoperations, and predictors of pooroutcome were evaluated. 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 treatedarthroscopically. 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 initialrecurrence 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 linearregression modeling identified intravenous drug abuse as the most significant predictor for final ASES score [F(1,18)= 6.12, p = .024, adjusted R2 = .254]. Following isolated shoulder joint sepsis, infection clearance and acceptable functional outcomes can beachieved using surgical I&D followed by a course of antibiotics, but outcomes are variable.Level of evidence: IV