Management of chronic deep infection following rotator cuff repair

Background: Deep infection of the shoulder following rotator cuff repair is uncommon. There are few reports in the literature regarding the management of such infections. Methods: We retrospectively reviewed the charts of thirteen patients and re corded the demographic data, clinical and laboratory findings, risk factors , bacteriological findings, and results of surgical management. Results: The average age of the patients was 63.7 years. The interval betwe en the rotator cuff repair and the referral because of infection averaged 9 .7 months. An average of 2.4 procedures,were performed prior to referral be cause of infection, and an average of 2.1 procedures were performed at our institution. All patients had pain on presentation, and most had a restrict ed range of motion. Most patients were afebrile and did not have an elevate d white blood-cell count but did have an elevated erythrocyte sedimentation rate. The most common organisms were Staphylococcus epidermidis, Staphyloc occus aureus, and Propionibacterium species. At an average of 3.1 years, al l patients were free of infection. Using the Simple Shoulder Test, eight pa tients stated that the shoulder was comfortable,vith the arm at rest by the side, they could sleep comfortably, and they were able to perform activiti es below shoulder level. However, most patients had poor overhead function. Conclusions Extensive soft-tissue loss or destruction is associated with a worse prognosis. Extensive debridement, often combined with a muscle transf er, and administration of the appropriate antibiotics controlled the infect ion, although most patients were left with a substantial deficit in overhea d function of the shoulder.