Long-term outcomes after infected mini-open rotator cuff repair: results of a 10-year review
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)
- et al.
Infection after mini open rotator cuff repair
J Shoulder Elbow Surg
(2002) - et al.
Scoring systems for the functional assessment of the shoulder
Arthroscopy
(2003) - et al.
Management of early deep infection after rotator cuff surgery
J Shoulder Elbow Surg
(2005) - et al.
Guideline for prevention of surgical site infection
Am J Infect Control
(1999) - et al.
Complications of rotator cuff repair
Orthop Clin North Am
(1997) - et al.
Satisfaction, function and repair integrity after arthroscopic versus mini-open rotator cuff repair
Bone Joint J
(2017) - et al.
Long-term longitudinal follow-up of mini-open rotator cuff repair
J Bone Joint Surg Am
(2013) - et al.
Recurrent infection of the rotator cuff after open repair: case report
J Shoulder Elbow Surg
(2006)
Cited by (6)
Polymorphisms and alterations in gene expression associated with rotator cuff tear and healing following surgical repair: a systematic review
2021, Journal of Shoulder and Elbow SurgeryMid- to Long-Term Outcomes After Deep Infections After Arthroscopic Rotator Cuff Repair
2020, Arthroscopy, Sports Medicine, and RehabilitationLittle benefit of surgical anchor and suture removal and of antibiotic therapy beyond 6 weeks in infected rotator cuff repair
2020, Journal of Shoulder and Elbow SurgeryCitation Excerpt :Our study population is not dissimilar to those sampled in prior studies. It shares the same predominance of middle-aged men,4,11,20 low serum C-reactive protein levels,7,14 presence of intraoperative lesions,7,15,20 prior surgeries,8,20 pathogens,7,11,15,17 patients' comorbidities,14,17,20 and sequelae (Table IV). The only difference is the lower remission rate in our study despite significantly longer-term antibiotic therapies (ie, 100% infection remission; Table IV), the exact reasons for which we have not listed here.
Intraoperative and Postoperative Issues With Open Rotator Cuff Repair
2020, Complications in Orthopaedics: Sports MedicineClinical and functional outcomes of a novel transosseous device to treat rotator cuff tears: A minimum 2-year follow-up
2019, Journal of Orthopaedic Surgery
The Barwon Health Research Ethics, Governance & Integrity (REGI) Unit has exempted this study from review: reference No. 16/43.