Review Question - QID 7904

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Total Shoulder Arthroplasty QID: 7904 (SAE11UE.116)

QID 7904 (Type "7904" in App Search)

A 68-year-old man with a history of diabetes and total shoulder arthroplasty 4 years ago, now reports increasing shoulder pain and stiffness. Radiographs show lucent lines around both the humeral and glenoid components. Laboratory studies show a white blood cell count of 12,600/mm3, an erythrocyte sedimentation rate of 72 mm/h, and a c-reactive protein of 3.5. The shoulder is aspirated and cultures are negative at 3 days. What is the most appropriate treatment for this patient?

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4-week trial of nonsteroidal anti-inflammatory drugs (NSAIDs)

0/3

Physical therapy for range-of-motion work

0/3

Repeat aspiration and culture

33%

1/3

Open irrigation and debridement with implant removal and possible exchange arthroplasty

67%

2/3

Arthroscopic irrigation and debridement

0/3

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The patient has clinical and radiographic signs of infection. Open debridement, component removal, an antibiotic spacer, and possible exchange arthroplasty are necessary to resolve the infection. Aspiration and culture can often be negative at 3 days. NSAIDs, sling immobilization, or physical therapy are not indicated. With radiographs indicating lucent lines surrounding the prosthetic implants, arthroscopic irrigation and debridement will not eradicate the infection.

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1.3

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