title: Detritic synovitis can mimic a Propionibacterium periprosthetic infection.
abstract: OBJECTIVE
  The purpose of this article is to illustrate that the clinical findings of detritic synovitis complicating a total shoulder arthroplasty can strongly resemble those of a 'stealth' periprosthetic shoulder infection with a low-virulence organism such as Propionibacterium.
  
  
  METHODS
  We present a review of the literature and illustrate an example of detritic synovitis following a total shoulder arthroplasty.
  
  
  RESULTS
  The combination of glenoid component loosening and humeral osteolysis after total shoulder arthroplasty are commonly attributed to periprosthetic infection with low virulence organisms, such as Propionibacterium or coagulase negative Staphylococcus. Such a periprosthetic infection can appear long after the index joint replacement. This article points out that these same findings may occur with a non-infectious process initiated by polyethylene, cement or metal debris-detritic synovitis.
  
  
  CONCLUSIONS
  At present, the important differentiation between these two etiologies can only be ascertained by awaiting the results of cultures obtained at the time of revision surgery.
authors.affiliation: University of Washington School of Medicine, 4333 Brooklyn Ave NE, Seattle, WA, 98105, USA. jgorbaty@uw.edu.
authors.forename: Jacob D
authors.initials: JD
authors.lastname: Gorbaty
authors.affiliation: Department of Orthopaedics and Sports Medicine, University of Washington, 1959 NE Pacific St, Box 356500, Seattle, WA, 98195, USA. robertmlucas@gmail.com.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Lucas
authors.affiliation: Department of Orthopaedics and Sports Medicine, University of Washington, 1959 NE Pacific St, Box 356500, Seattle, WA, 98195, USA. matsen@u.washington.edu.|Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA. matsen@u.washington.edu.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Matsen
mesh_terms: D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000379:methods; D003937:Diagnosis, Differential; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis*; D006801:Humans; D011424:Propionibacterium / Q000302:isolation & purification*; D016459:Prosthesis-Related Infections / Q000175:diagnosis*; D012086:Reoperation / Q000379:methods; D012785:Shoulder Joint / Q000473:pathology / Q000601:surgery*; D013585:Synovitis / Q000175:diagnosis* / Q000209:etiology; D016896:Treatment Outcome
keywords: Detritic synovitis; Osteolysis; Periprosthetic shoulder infection; Total shoulder failure