J Korean Orthop Assoc.  2015 Apr;50(2):154-159. 10.4055/jkoa.2015.50.2.154.

Mycobacterium tuberculosis Infection in the Shoulder after Reverse Total Shoulder Arthroplasty

• Kim JH
• Kim JY
• Sagong SY

• KMID: 2106752
• DOI: http://doi.org/10.4055/jkoa.2015.50.2.154

Abstract

Reverse total shoulder arthroplasty has recently received attention for treatment of rotator cuff tear arthropathy. However, many complications of reverse total shoulder arthroplasty have also been reported, and infection is a major complication. We are reporting on a case of an approximately 77-year-old female patient who underwent reverse total shoulder arthroplasty with surgical site infection caused by Mycobacterium tuberculosis. The patient had undergone irrigation and debridement two times due to infectious signs at 8 months after a reverse total shoulder arthroplasty. At the last debridement operation, we performed AFB staining, culture for Mycobacterium tuberculosis and biopsy. Mycobacterium tuberculosis was cultured and we did not hesitate to administer 4 regimen therapy for tuberculosis. The outpatient follow-up result was satisfactory without recurrence. At the time of the latest follow-up, the degree of pain and function were good.

Keyword

reverse total shoulder arthroplasty; mycobacterium tuberculosis; infection; sinus tract

MeSH Terms

Aged
Arthroplasty*
Biopsy
Debridement
Female
Follow-Up Studies
Humans
Mycobacterium tuberculosis*
Outpatients
Recurrence
Rotator Cuff
Shoulder*
Tuberculosis

Figure

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  Figure 1 Preoperative anteroposterior radiograph of the right shoulder in a 77-year-old woman with prior cemented reverse total shoulder arthroplasty, demonstrating none of the specific another abnormal findings.

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  Figure 2 Anteroposterior radiograph of the right humerus after implant removal, demonstrating the placement of a cement spacer impregnated with antibiotics. Successful placement of the osteotomized proximal humeral shaft with cerclage wires.

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  Figure 3 Microscopic findings of right shoulder joint (H&E, ×100). Acute and chronic inflammatory reaction (A) and focal foreign body reaction, probably related to the previous arthroplasty (B) are observed.

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  Figure 4 Anteroposterior radiograph of the right shoulder after second replacement of a cement spacer impregnated with antibiotics, demonstrating none of the humeral head portion. Skin was sutured with wire.

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  Figure 5 Anteroposterior radiograph of the right humerus after removal of previous antibiotics-impregnated cement spacer.

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  Figure 6 Microscopic findings of right shoulder joint. Focal granulomatous reaction consisted of epithelioid cells and Langhans type giant cells (arrows), suggestive of tuberculosis, is noted (H&E, ×40).

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