Infections After Shoulder Surgery

The success rate of shoulder surgery is very high, however, there are possible complications, the most concerning being an infection.

Why Infections Occur

Most shoulder infections resulting from surgery are caused by bacteria that are normally found on the surface of your skin. These bacteria can get access to the deeper soft-tissues and joint spaces in your shoulder when your skin is cut. If the infectious organisms make their way into these deeper tissues, and your body’s immune defense doesn’t adequately protect you from them, you might develop an infection.

Risk factors that can predispose you to shoulder infections after surgery include:

• Malnutrition
• Diabetes
• Obesity
• Tobacco use
• Advanced age
• Immunosuppressive conditions, such as cancer, liver or kidney failure
• Immunosuppressive medications, including prednisone or chemotherapy

Sometimes, incisions for shoulder surgery are located very near to the axilla (armpit). The axilla is the location of many sebaceous glands and hair follicles that create an environment that fosters bacterial growth.

Preventing Infections

Shoulder surgery is a treatment used for conditions ranging from shoulder arthritis to rotator cuff tears. These procedures can be done as minimally invasive arthroscopic surgeries or as more traditional open surgeries with larger incisions.

Several steps can be taken to help prevent a shoulder infection after surgery:

• Some surgeons ask their patients to shower with special soap prior to coming to the hospital for their surgery, and while this hasn’t been proven to be helpful, it is becoming more common.
• Administration of an intravenous (IV, in a vein) antibiotic is given within one hour of the start of surgery. It is not typically necessary to take additional antibiotics after surgery.
• Many surgeons will remove armpit hair right before surgery, although this actually hasn’t been shown to make a significant difference in the likelihood of developing an infection. If armpit hair is removed, it should be done with clippers and not a razor, as the microabrasions caused by a razor have been shown to increase the likelihood of postoperative infection.
• Cleansing the surgical location with a solution composed of a combination of alcohol and chlorhexidine.

While your wound is healing after surgery, it’s important to keep it clean and to follow instructions about wound care and dressing changes.

Is It an Infection?

Anyone who has shoulder surgery can be expected to have some discomfort and swelling around the shoulder—which are also common signs of infection.

Because there’s an overlap between some regular postoperative symptoms and the symptoms of an infection, your healthcare provider will check your wound for infection by looking for more specific signs.

Signs of infection include:

• Redness around the incision
• Drainage from the incision, particularly purulent fluid
• Increasing pain (rather than gradually decreasing)
• Fevers, chills, or sweats

If you develop any of these signs, you should let your surgeon know right away. Early diagnosis and treatment will prevent progression and lead to a better outcome.

Your surgeon might order additional tests, such as blood tests, which can show signs of an infection, like elevated white blood cells. If your incision is draining, the fluid from the wound can be examined to identify infectious organisms. However, this isn’t usually done since it leads to many false positives (results saying there is an infection when there isn’t).

If your incision is sealed, your healthcare provider may place a needle into the deeper layers of your shoulder to obtain a sample of fluid for analysis.

The most common types of bacteria that cause infection after shoulder surgery include Staph infections (both S. aureus and S. epidermis) and Propionibacterium infections (P.acnes). Infections caused by P. acnes are unusual and are typically associated with the shoulder joint. And P. acnes infections are especially challenging because the organism can be hard to detect in fluid analysis samples, and may require special testing procedures for diagnosis.

Treatment of Infection

Treatments strategies include oral or IV antibiotics and additional surgical procedures to clean the joint. In general, more superficial (closer to the skin) infections can be managed with antibiotics.

Because the shoulder joint space has limited immune defenses, once the infection enters the ball-and-socket joint space, infections can become persistent. Deeper infections, especially those that enter the joint space of the shoulder, are more likely to require additional surgery and prolonged intravenous antibiotics.

The areas around surgical implants, such as anchors, plates, or prosthetic replacements, can become infected. Infections associated with implants can be severe and may require intense treatment. Sometimes persistent infections necessitate the removal of implanted material.

Rare but Serious

Shoulder infections are uncommon complications of shoulder surgery. Prevention of postsurgical infections involves steps that begin during pre-operative preparation, as well as infection prevention strategies during and after surgery. If you have any signs of an infection, early diagnosis and prompt treatment are ideal.