Application of the ICM diagnostic criteria for shoulder periprosthetic joint infection

Abstract

BackgroundDiagnosis for shoulder periprosthetic infection (PJI) is a challenge in shoulder arthroplasty. The 2018–2019 International Consensus Meeting (ICM) on Orthopedic Infections created a scoring system with minor and major criteria for shoulder PJI. The purpose of this study was to apply these criteria in a cohort of suspected shoulder PJI cases and assess their treatment course. MethodsAn institutional database was used to query TSA patients from January 2013 to May 2019. Patients for revision shoulder arthroplasty were stratified into groups based on the ICM criteria with four main groups: unlikely PJI, possible PJI, probable PJI, and definite PJI. Each patient included was assessed for baseline demographics, Elixhauser co-morbidities (ECM), prior hardware, timing of infection, treatment type, reinfection incidence at one-year, length of hospitalization and 90-day readmission. ResultsA total of 43 patients were identified. After applying ICM criteria for diagnosis of shoulder PJI, there were 16 cases of unlikely PJI, 15 cases of possible PJI, 5 cases of probable PJI and 7 cases of definite PJI. Comparison of baseline characteristics including age (p = 0.23), BMI (p = 0.62), ASA (p = 0.53) reveled no significant differences between each ICM group. C. acnes was not found in any case of definite PJI. Definite PJI had the highest LOS at 2.6 days, p = 0.04. Revision for PJI that was classified as definite infection demonstrated the highest rate of reinfection at 1-year (28.6%) (p = 0.02). ConclusionICM criteria represent an accurate and reliable tool for defining shoulder PJI. Moreover, the criteria appear to demonstrate a higher risk of reinfection in the definite PJI group. Based on these findings, we recommend careful consideration of treatment strategies due to higher risk for reinfection Level of evidenceLevel IV; Retrospective Cohort.