title: Infection after primary anatomic versus primary reverse total shoulder arthroplasty.
abstract: BACKGROUND
  Deep periprosthetic infection is a serious complication after total shoulder arthroplasty (TSA) and is associated with suboptimal clinical results. This retrospective study aimed to determine whether a difference in infection rate existed after primary anatomic TSA (aTSA) and primary reverse TSA (rTSA).
  
  
  METHODS
  A TSA database was retrospectively reviewed to identify primary TSAs performed from 2004 to 2012 and isolate cases of confirmed deep periprosthetic infection. Data collected included age, sex, preoperative diagnosis, previous nonarthroplasty operative history, implant type, and infecting organism.
  
  
  RESULTS
  From 814 primary TSAs performed, deep periprosthetic infections were confirmed in 16 shoulders. Infections occurred in 6 aTSAs and 10 rTSAs, with no significant difference among the prosthesis types. Pathogens included Staphylococcus spp, Propionibacterium acnes, and Escherichia coli. In the subgroup of shoulders with no previous operations, no significant difference in infection rate was found among the prosthesis types. Shoulders with previous nonarthroplasty operations undergoing primary TSA exhibited a significantly higher (P = .016) infection rate compared with shoulders with no operative history. Both aTSA and rTSA performed in previously operated-on shoulders demonstrated higher infection rates compared with shoulders with no prior operative intervention. The infection rate was significantly higher (P = .016) in the rTSA group.
  
  
  CONCLUSIONS
  There is no difference in infection rate after primary aTSA and primary rTSA in shoulders that have not undergone previous operative interventions. Infection is more likely to develop in shoulders undergoing primary rTSA that have had one or more nonarthroplasty operative procedures.
authors.affiliation: Department of Orthopaedic Surgery, Georgia Regents University, Augusta, GA, USA.
authors.forename: Anthony V
authors.initials: AV
authors.lastname: Florschütz
authors.affiliation: Department of Orthopaedic Surgery, Georgia Regents University, Augusta, GA, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Lane
authors.affiliation: Department of Orthopaedic Surgery, Georgia Regents University, Augusta, GA, USA. Electronic address: lycrosby@gru.edu.
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Crosby
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000601:surgery*; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000601:surgery*; D013530:Surgical Wound Infection / Q000175:diagnosis* / Q000453:epidemiology
keywords: TSA; Total shoulder arthroplasty; anatomic; complication; infection; primary; reverse