Surgical Treatment of Shoulder Infection Following Rotator Cuff Repair

Document Type : RESEARCH PAPER

Authors

1 Cedars-Sinai Medical Center, Los Angeles, CA, USA

2 Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA

3 Cleveland Clinic, Cleveland, OH, USA

Abstract

Background: Deep infection after rotator cuff repair (RCR) can cause significant morbidity and healthcare burden. 
Outcomes of surgical treatment of infection following RCR are limited. This study aimed to assess the clinical 
course and outcomes related to surgical management of deep infection following RCR.
Methods: Patients treated with debridement for infection after RCR at a single institution were included. 
Postoperative deep infection included the following criteria: persistent drainage more than five days from index 
surgery, development of a sinus tract to the joint, ≥ 2 positive cultures at the time of revision surgery with the same 
bacteria, or presence of purulence. Functional outcomes (ASES, SANE, SF-12) were assessed at a minimum of 
1-year post-debridement. 
Results: Twenty-three patients were included and analyzed at mean six years post-debridement. All were free 
of infection at the final follow-up. The average age was 55 years; fifteen (65.2%) had infection after primary RCR 
and eight (34.8%) after revision RCR. Twelve (52.2%) patients required a repeat debridement prior to eradicating 
infection for an average of 1.9 surgeries before clearance of infection. Statistically significant predictors of need 
for a repeat debridement included initial open RCR (P = .02), open debridement (P = .002) and infection requiring 
IV antibiotics (P = .014). Postoperative ASES, SANE, SF-12M, SF-12P, and satisfaction scores were 71.7±25.7, 
67.0±28.1, 55.5±6.5, 38.4±14.3 and 3.7±1.3, respectively. 
 
Conclusion: Deep infection after RCR can be treated with open or arthroscopic debridement. However, more than 
50% of patients may require multiple debridements. Final functional results after infection control following RCR are 
satisfactory. However, chronic infection predicts worse functional outcomes. 
Level of evidence: IV 

Keywords

Main Subjects

References

1. Athwal GS, Sperling JW, Rispoli DM, Cofield RH. Deep 
infection after rotator cuff repair. J Shoulder Elbow 
Surg. 2007; 16(3):306–11. https://doi.org/10.1016/j.
jse.2006.05.013.
2. Kwon YW, Kalainov DM, Rose HA, Bisson LJ, Weiland AJ. 
Management of early deep infection after rotator cuff 
repair surgery. J Shoulder Elbow Surg. 2005; 14(1):1–
5. https://doi.org/10.1016/j.jse.2004.04.010.
3. Settecerri JJ, Pitner MA, Rock MG, Hanssen AD, Cofield 
RH. Infection after rotator cuff repair. J Shoulder 
Elbow Surg .1999; 8(1):1–5.
4. Pauzenberger L, Grieb A, Hexel M, Laky B, Anderl W, 
Heuberer P. Infections following arthroscopic rotator 
cuff repair: incidence, risk factors, and prophylaxis. 
Knee Surg Sports Traumatol Arthrosc. 2017; 
25(2):595–601. https://doi.org/10.1007/s00167-
016-4202-2.
5. Yeranosian MG, Arshi A, Terrell RD, Wang JC, McAllister 
DR, Petrigliano FA. Incidence of acute postoperative 
infections requiring reoperation after arthroscopic 
shoulder surgery. Am J Sports Med. 2014; 42(2):437–
41. https://doi.org/10.1177/0363546513510686.
6. Baker DK, Perez JL, Watson SL, et al. Arthroscopic 
Versus Open Rotator Cuff Repair: Which Has a Better 
Complication and 30-Day Readmission Profile? 
Arthroscopy.2017; 33(10):1764–9. https://doi.
org/10.1016/j.arthro.2017.04.019.
7. Vopat BG, Lee BJ, DeStefano S, et al. Risk Factors for 
Infection After Rotator Cuff Repair. Arthroscopy.2016; 
32(3):428–34. https://doi.org/10.1016/j.arthro.2015. 
08.021.
8. Lindley K, Jones GL. Outcomes of arthroscopic versus 
open rotator cuff repair: a systematic review of 
the literature. Am J Orthop (Belle Mead NJ). 2010; 
39(12):592–600.
9. Nho S, Shindle M, Sherman S, Freedman K, Lyman 
S, MacGillivray J. Systematic Review of Arthroscopic 
Rotator Cuff Repair and Mini-Open Rotator Cuff 
Repair. J Bone Jt Surg-Am .2007; 89(S3):127–36. 
https://doi.org/ 10.2106/JBJS.G.00583.
10.Jenssen KK, Lundgreen K, Madsen JE, Dimmen S. 
Targeted intervention of acute postoperative infection 
after rotator cuff repair results in good functional 
outcomes. Knee Surg Sports Traumatol Arthrosc. 
2018; 26(1):285–91. https://doi.org/10.1007/
s00167-017-4743-z.
11.Saltzman MD, Marecek GS, Edwards SL, Kalainov 
DM. Infection after shoulder surgery. J Am Acad 
Orthop Surg. 2011; 19(4):208–18. https://doi.org/ 
10.5435/00124635-201104000-00005.
12.Mirzayan R, Itamura JM, Vangsness CT, Holtom PD, 
Sherman R, Patzakis MJ. Management of chronic 
deep infection following rotator cuff repair. J Bone 
Joint Surg Am 2000; 82(8):1115-21. https://doi.org/ 
10.2106/00004623-200008000-00008.
13.Paxton E, Teefey S, Dahiya N, Keener J, Yamaguchi 
K, Galatz L. Clinical and Radiographic Outcomes 
of Failed Repairs of Large or Massive Rotator Cuff 
Tears: Minimum Ten-Year Follow-up. J Bone Jt Surg 
Am. 2013; 95(7):627–32. https://doi.org/10.2106/
JBJS.L.00255.
14.Tashjian RZ, Hollins AM, Kim H-M, et al. Factors Affecting 
Healing Rates after Arthroscopic Double-Row Rotator 
Cuff Repair. Am J Sports Med. 2010; 38(12):2435–42. 
https://doi.org/10.1177/0363546510382835.
15.Hsu JE, Bumgarner RE, Matsen FA. Propionibacterium 
in Shoulder Arthroplasty: What We Think We Know 
Today. J Bone Joint Surg Am. 2016; 98(7):597–606. 
https://doi.org/10.2106/JBJS.15.00568.
The Archives of Bone and Joint Surgery
Volume 11, Issue 2
February 2023
Pages 111-116

Files

History

  • Receive Date: 12 October 2020
  • Revise Date: 08 August 2022
  • Accept Date: 13 August 2022

Share

How to cite

Statistics