NURİ AYDIN, EVRİM ŞİRİN, AHMET NADİR AYDEMİR, Gökhan ZENGİN

Pseudomonas osteomyelitis of the proximal humerus after arthroscopic rotator cuff repair

A 59-year-old male patient was operated arthroscopically due to a rotator cuff tear. An early postoperative Pseudomonas aeruginosa infection was treated with early arthroscopic debridement and antibiotic therapy. The patient was lost to follow-up and presented to our clinic with Pseudomonas aeruginosa osteomyelitis after two years. Debridement was again performed and antibiotic-impregnated cement beads were filled into the cavity and taken out 6 weeks postoperatively. No findings of infection were observed at the patients 2nd year follow-up. To our knowledge, this is the first case of Pseudomonas aeruginosa osteomyelitis of the shoulder after arthroscopic rotator cuff repair.

___

1. Mansat P, Cofield RH, Kersten TE, Rowland CM. Complications of rotator cuff repair. Orthop Clin North Am 1997;28:205-13.

2. Settecerri JJ, Pitner MA, Rock MG, Hanssen AD, Cofield RH. Infection following open repair of the rotator cuff. Orthop Trans 1997;20:949.

3. Martin CT, Gao Y, Pugely AJ, Wolf BR. 30-day morbidity and mortality after elective shoulder arthroscopy: a review of 9410 cases. J Shoulder Elbow Surg 2013;22:1667-75.

4. Mirzayan R, Itamura JM, Vangsness CT Jr, Holtom PD, Sherman R, Patzakis MJ. Management of chronic deep infection following rotator cuff repair. J Bone Joint Surg Am 2000;82-A:1115-21.

5. Dan M, Siegman-Igra Y, Pitlik S, Raz R. Oral ciprofloxacin treatment of Pseudomonas aeruginosa osteomyelitis. Antimicrob Agents Chemother 1990;34:849-52.

6. Mayberry-Carson KJ, Tober-Meyer B, Smith JK, Lambe DW Jr, Costerton JW. Bacterial adherence and glycocalyx formation in osteomyelitis experimentally induced with Staphylococcus aureus. Infect Immun 1984;43:825-33.

7. Letts RM, Doermer E. Conversation in the operating theater as a cause of airborne bacterial contamination. J Bone Joint Surg Am 1983;65:357-62.

8. Aydin N, Esemenli T. Sweating: a formidable challenge in orthopaedic surgery. J Hosp Infect 2010;75:236-7.

9. Armstrong RW, Bolding F. Septic arthritis after arthroscopy: the contributing roles of intraarticular steroids and environmental factors. Am J Infect Control 1994;22:16-8.

10. Herrera MF, Bauer G, Reynolds F, Wilk RM, Bigliani LU, Levine WN. Infection after mini-open rotator cuff repair. J Shoulder Elbow Surg 2002;11:605-8.

11. Masini BD, Stinner DJ, Waterman SM, Wenke JC. Bacterial adherence to high--tensile strength sutures. Arthroscopy 2011;27:834-8.

12. Busfield BT. Glenohumeral joint sepsis after magnetic resonance imaging arthrogram. Am J Orthop (Belle Mead NJ) 2012;41:277-8.

13. Klinger HM, Baums MH, Freche S, Nusselt T, Spahn G, Steckel H. Septic arthritis of the shoulder joint: an analysis of management and outcome. Acta Orthop Belg 2010;76:598-603.

14. Duncan SF, Sperling JW. Treatment of primary isolated shoulder sepsis in the adult patient. Clin Orthop Relat Res 2008;466:1392-6.

15. Harding JW, Braddock GT, Croydon EA. Successful treatment of osteomyelitis caused by Pseudomonas aeruginosa. J Clin Pathol 1970;23:653-6.

16. Kanellakopoulou K, Giamarellos-Bourboulis EJ. Carrier systems for the local delivery of antibiotics in bone infections. Drugs 2000;59:1223-32.

17. Bowyer GW, Cumberland N. Antibiotic release from impregnated pellets and beads. J Trauma 1994;36:331-5.

18. Parnes N, DeFranco M, Wells JH, Higgins LD, Warner JJ. Complications after arthroscopic revision rotator cuff repair. Arthroscopy 2013;29:1479-86.

19. Pandey V, Varghese E, Rao M, Srinivasan NM, Mathew N, Acharya KK, et al. Nonfatal air embolism during shoulder arthroscopy. Am J Orthop (Belle Mead NJ) 2013;42:272-4.

20. Austin L, Zmistowski B, Tucker B, Hetrick R, Curry P, Williams G Jr. Commercial liquid bags as a potential source of venous air embolism in shoulder arthroscopy. J Bone Joint Surg Am 2010;92:2110-4.

21. Canale ST, Beaty JH. Campbells Operative Orthopaedics. 12th ed. Philadelphia: Elsevier Mosby; 2013. p. 2374-5.

22. Meislin RJ, Halbrecht J. Complications in Knee and Shoulder Surgery. London: Springer-Verlag; 2009. p. 238-9.