Long-term outcomes after infected mini-open rotator cuff repair: results of a 10-year review

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Background

Infection after rotator cuff repair (RCR) is uncommon. There are few reports in the literature regarding the management and long-term results of patients in whom deep infection of the shoulder develops after RCR. The objective of this study was to assess the long-term clinical and radiologic outcomes of these patients.

Methods

We retrospectively reviewed a consecutive series of 764 patients after mini-open RCR in which 9 patients had postoperative infection. The demographic data, clinical and laboratory findings, risk factors, bacteriologic findings, and results of surgical management were analyzed. All patients underwent clinical and radiologic assessment at long-term follow-up of approximately 10 years after infection.

Results

The mean age of the patients was 56.2 years. The mean time to presentation for infection after RCR was 16 days. All patients had pain on presentation, and 6 patients had persistent discharge from their wounds with erythema. The most common organism was Staphylococcus aureus. At final follow-up at a mean of 11.62 years after surgery, the mean Simple Shoulder Test score was 10.5 and the mean Constant score was 70. The rotator cuff was intact in 5 of 7 patients.

Conclusion

With appropriate treatment, eradication of infection can be achieved, and in appropriate cases, anchors can be retained. Reasonable long-term functional outcome scores can be achieved.

Section snippets

Patient population

Between November 2002 and August 2006, a total of 764 patients underwent RCR surgery across a combination of 4 public and private hospitals in our regional area. Of the 764 patients, 9 patients in this retrospective case series were identified in whom a postoperative infection developed. The overall incidence of infection was 1.2%.

Deep surgical site infection was defined by the Centers for Disease Control and Prevention guidelines.9 Infection was diagnosed when at least 1 of the following

Patient demographics

All 9 patients who had a postoperative infection were male. The mean age was 56.2 years (range, 43-67 years) (Table I). One case was compensable under workers' compensation.

Risk factors

Associated medical illnesses were uncommon. One patient had a history of ischemic heart disease. No patients were diabetic or immunosuppressed, and none were smokers. There were no local predisposing factors, such as previous wounds or prior shoulder surgery. Two patients had subacromial cortisone injections administered 4

Discussion

Infection after RCR is a relatively rare occurrence but can result in significant pain and disability for patients. Our incidence of infection of 1.2% is similar to that of other studies, in which open and mini-open RCR infection rates have ranged from 0.27% to 1.9%.5, 10, 12, 16

Corticosteroid injections have previously been implicated as a local risk factor for infection. However, a review of >300 corticosteroid injections suggested that this is an extremely rare complication.7 Kwon et al8

Conclusion

An infection after RCR is uncommon. A high index of suspicion is required, but most are manifested in a typical fashion. Retention of anchors and suture material does not appear to be detrimental, and single-stage revision at the time of débridement is possible with good results if the patient presents acutely with a sensitive organism. However, clearing of infection must be the primary aim of treatment.

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

References (17)

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The Barwon Health Research Ethics, Governance & Integrity (REGI) Unit has exempted this study from review: reference No. 16/43.

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