Investigation and Management of Periprosthetic Joint Infection in the Shoulder and Elbow: Evidence and consensus based guidelines of the British Elbow and Shoulder Society.

Abstract

1.1 Background Periprosthetic Joint Infection (PJI) is a relatively rare but potentially devastating complication affecting shoulder and elbow joint arthroplasty. The increasing use of these procedures in the surgical management of arthritis and trauma means that the incidence of PJI is also likely to rise. The much larger burden of PJI in hip and knee arthroplasty has made international groups develop consensus definitions on diagnosis and guidance on investigations required to confirm PJI.1–3 Infection reported as a cause for revision within the UK National Joint Registry (NJR) currently is 0.27% for shoulder arthroplasty and 1.13% for elbow arthroplasty.4 Although the numbers of PJI are relatively low with shoulder and elbow arthroplasty the impact on patients, the treating surgical teams and healthcare resources remains significant. Scoping reviews of the current body of literature on shoulder and elbow PJI confirmed a limited quality of published papers, mostly based on small retrospective case series and cohort studies.5,6 The British Elbow and Shoulder Society (BESS) has therefore developed these clinical guidelines on investigation and management of shoulder and elbow PJI by combining available evidence from the literature with consensus developed by a working group of BESS surgeons, infectious disease physicians and BESS physiotherapists.