Risk of Infection Following Reverse Shoulder Arthroplasty After Failed Rotator Cuff Repair: A Retrospective Review

Risk of Infection Following Reverse Shoulder Arthroplasty After Failed Rotator Cuff Repair: A Retrospective Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Risk of Infection Following Reverse Shoulder Arthroplasty After Failed Rotator Cuff Repair: A Retrospective Review Jacob Mogerman, Zachary Tamweber, Lin Feng, Haider Mohammed, Thomas Duquin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7551849/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Rotator cuff repair (RCR) is a treatment option for rotator cuff tear, but the failure rate is 11-57%, requiring reverse shoulder arthroplasty (RSA). Due to its success, indications for RSA have expanded to include patients who failed RCR without significant arthritis. Periprosthetic joint infection (PJI) rate after RSA (with prior RCR or not) is 2.4% and unexpected positive intra-operative cultures (UPIC) is 17%.. This study aims to identify infection rates in a historic cohort undergoing RSA who previously had an RCR. Material and Methods Medical records between 2015-2023 from one university hospital were screened for adult patients undergoing RSA for rotator cuff tear who have previously undergone ipsilateral RCR. Intraoperative samples were obtained in patients at high risk of PJI. PJI and UPIC rates were calculated and compared to the population norm using one-sample proportion test. Results During enrollment period, 92 patients (73.9 years, 42% male, 29.7kgm-2) met inclusion criteria and cultures were obtained from 23 high risk patients (72.1 years, 52% male, 31.1kgm-2). Two PJI were identified (80 y/o M and 83 y/o M), which corresponds to a PJI rate of 2.2%, which is not significantly different than the population norm. Of the remaining 21 cultures, 5 (23.8%) were UPIC of P. acnes, which was also not different. Minimal demographic or clinical differences were observed between those that had a negative culture and those that had UPIC. Discussion Our study found no increase in PJI or UPIC in patients undergoing RSA following ipsilateral RCR compared to previous reports on the general risk of infection for RSA alone. Although not the primary aim, the 23.8% incidence of UPIC in patients with suspected PJI is higher than the population norm of 17%. While this result was not statistically significant, it prompts discussion on developing guidelines for intraoperative culture sampling specific to patients with multiple ipsilateral shoulder surgeries. Level of Evidence: Level III- Retrospective Cohort Study Rotator Cuff Repair (RCR) Reverse Shoulder Arthroplasty (RSA) Periprosthetic Joint Infection (PJI) Unexpected Positive Intra-operative Cultures (UPC) Ipsilateral Shoulder Surgery INTRODUCTION Rotator cuff tears are common injuries ranging from a small tear of less than 1cm to a massive tear of greater than 5cm 4 . Treatment of these tears most commonly consists of one or more of the following procedures: conservative non-operative/ physical therapy/ corticosteroid injection, arthroscopic debridement with the possibility of either partial repair, biceps tenotomy/ tenodesis, superior capsular repair, arthroscopic tendon transfer of latissimus dorsi or trapezius, or reverse shoulder arthroplasty (RSA). Rotator cuff repair (RCR) has historically been the primary intervention for patients who have failed non-surgical management. However, the rates of failed rotator cuff repair can range from 11%, up to 57% in some cases 8 , 12 . The management of a failed rotator cuff repair can include revision repair, superior capsule reconstruction, tendon transfers or RSA. Due to the success of RSA in patients with rotator cuff arthropathy and glenohumeral arthritis, indications have expanded to include patients with irreparable rotator cuff tears or those who have failed rotator cuff repair without significant arthritis 6 . While RSA is a viable and reliable secondary surgical intervention for failed rotator cuff repairs, patients who underwent arthroplasty as primary intervention instead had better overall improvement 3 . Demographically, patients who underwent RSA revision after initial rotator cuff repair were older and had a greater number of comorbidities. Furthermore, these patients typically required an RSA either within the first year, or greater than five years after their initial rotator cuff repair 2 . Currently, there is conflicting evidence regarding how previous surgery influences success of RSA 9 , 11 . The global rate of complications in patients with RSA is 24%, with 3.8% of complications attributable to infection 13 . However, the difference in risk of periprosthetic joint infection (PJI) between RSA as a primary or secondary surgical intervention for rotator cuff tear has yet to be explored. The objective of this study was to perform a retrospective chart review to determine if there is a significant difference in the rate of infection between patients who have failed rotator cuff repair and subsequently undergone RSA versus patients with RSA as the primary surgical intervention for their rotator cuff repair. We hypothesize that patients with ipsilateral RCR prior to RSA will have increased incidence of periprosthetic joint infection. A secondary objective of the study is to quantify and describe the incidence of unexpected positive intraoperative cultures (UPIC) in the study population. Unexpected positive intraoperative cultures (UPIC) are defined as intraoperative culture results that return positive in a patient with presumed aseptic revision surgery and no signs or symptoms of infection or laboratory findings indicative of an infective process 1 . Hodakowski et al. reported that the prevalence of UPIC in suspected aseptic shoulder arthroplasty is up to 27.5% 7 . The clinical meaning of UPICs is controversial as UPICs may represent contamination of the collected samples or a low-grade sub-clinical infection. UPICs that represent true infections may have even contributed to the failure of the arthroplasty 10 . While UPICs were not included in the infected group in this study, they still represent an interesting test result warranting further investigation. METHODS The protocol for this retrospective chart review was reviewed and approved by the University at Buffalo IRB. All patients were seen at one large university-affiliated orthopedics and sports medicine practice. Patient Population Male and female adult (≥ 18 years in age) patients were included in the analyses if they had received reverse shoulder arthroplasty following ipsilateral rotator cuff repair from January 1, 2015 – July 1, 2023. Individual records were excluded if the patient did not undergo RCR prior to ipsilateral RSA or had less than 2 years of follow-up data post-RSA. Data Collection Electronic medical records (EMR) were screened from January 1, 2015 – July 1, 2023 for patients undergoing reverse shoulder arthoplasty following ipsilateral rotator cuff repair. All clinical data was extracted from the EMR, including the following clinical characteristics: age, sex, race, ethnicity, handedness, and body mass index (BMI). Extracted data was manually screened to confirm their diagnosis and treatment. All disagreements were reviewed by the senior author before excluding. Main Outcome Measure Infection was defined using the criteria outlined during 2018 International Meeting on Orthopedic Infections. A definite PJI was defined as meeting one or more of the following three criteria: presence of a sinus tract, gross intra-articular pos, and/ or two positive tissue cultures with a phenotypically identical virulent organism 5 . The incidence rate of infection following RSA in the sample population was compared to the global rate of infection using a one sample binomial test. Statistical Analysis Univariate statistics for the entire sample were calculated. Patients with definitive PJI were identified and an incidence rate was calculated by dividing the number of definite cultures by the total sample size. In those PJI negative patients with cultures, we compared those that had negative and unexpected positive cultures. A z-test of proportion was used to compare incidence of unexpected positive results to a previously published rate of 17%. Number of times cultures were calculated and compared. Due to the small sample sizes, a Mann Whitney U test was used to compare continuous variables and a Chi-squared test was used for categorical outcomes. A p-value of < .05 is considered statistically significant. All statistical analysis was performed using SPSS Version 29. RESULTS Of the 92 patients who met the inclusion criteria, 64 were male and 28 were female, with an average BMI of 29.7 ± 6.3. Other descriptive statistics for the study population are included in table 1. Two patients met the criteria for definite periprosthetic joint infection (2.2%). The 2.2% incidence of PJI in our study population of patients with RSA following ipsilateral RCR is not significantly different from the 3.8% general incidence of infection following RSA (p = 0.294). Meaningful statistical differences between the infected group (n = 2) and uninfected group (n = 90) were limited by the small sample size. Instead, a description of infected patient data is included in table 2. Infected patient #1 did not undergo revision RSA for periprosthetic joint infection. Infected patient #2 underwent revision RSA with simultaneous washout. Of the remaining 90 patients without definite periprosthetic joint infection, 21 patients had at least one intraoperative culture at the time of their RSA due to clinical suspicion of shoulder infection. 5 of these 21 patients had unexpected positive intraoperative cultures (23.8%). All patients with UPIC were infected with Proprioni acnes , a nonvirulent organism. Infection via a nonvirulent organism without other signs of gross infection prevented the group from fulfilling PJI criteria. Patients in the unexpected positive intraoperative culture (UPIC) group had a significantly higher preoperative active range of forward elevation (p = .05) compared to the negative culture group. There were no other significant differences between the two groups for all other study parameters. The number of intraoperative cultures collected in the UPIC group did not differ significantly from the negative culture groups. DISCUSSION Contrary to the study hypothesis, there is no statistically significant difference between the rate of infection in patients following RSA with prior ipsilateral RCR and the established rate of infection following RSA (p = 0.294). These results align with the current treatment algorithm, which recommends RCR as the primary surgical intervention, reserving RSA for salvage procedures. This is not to say that RSA is an inappropriate primary intervention in all patients; however, given that RCR is less invasive than RSA and generally confers greater postoperative range of motion, patients may elect to attempt RCR first. This is especially true in younger patients who may expect a greater return to baseline after surgery. The variability in the number of intraoperative cultures drawn during RSA in patients with prior RCR observed in this study led to discussion on culture protocol for shoulder reoperations. Intraoperative cultures for open shoulder surgery yield a 17% false-positive rate, and current guidelines recommend collecting a minimum of 3, but ideally 5 to 6, cultures. In addition to testing errors, patients without clinically significant signs of infection may test positive for nonvirulent organisms, such as those infected with P. acnes in this study. Increasing the number of cultures drawn increases risk of false-positive test results and the risk of unexpected positive cultures in patients without signs of infection. Therefore, future studies should aim to standardize intraoperative protocols for this patient population such that definite periprosthetic joint infections can be identified in the fewest number of cultures possible. Additionally, there is a need for future work to standardize antibiotic regiments for patients with unexpected positive cultures, particularly for non-virulent organisms such as P. acnes . The combination of an appropriate intraoperative culture protocol and a standardized antibiotic course for patients with unexpected positive intraoperative cultures may confer fewer shoulder reoperations and improved patient outcomes. As a secondary benefit, defined indications and outlines can help reduce antibiotic overuse and the development of antibiotic-resistant organisms. CONCLUSION Electing to undergo RSA as the primary surgical intervention in the management of rotator cuff tear does not confer decreased risk of infection. The similar rates of infection between RSA as primary or secondary surgical intervention suggests that RCR is still an appropriate primary surgical intervention. Declarations COI : The authors above declares that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding : None Contributions: Jacob Mogerman, BS – JM- Methodology, Conceptualization, Writing – Review & Editing Zachary Tamweber, BS – ZT- Methodology, Conceptualization, Writing – Review & Editing Lin Feng, MS – LF- Project Administration M. Nadir Haider, MD, PhD- NH- Analysis Thomas Duquin, MD- TD- Validation, Supervision IRB Approval : STUDY00007950 approved on 12/14/2023 References Aldahamsheh O, Burger LD, Evaniew N, Swamy G, Jacobs WB, Thomas KC, et al. Unexpected intraoperative positive culture (UIPC) in presumed aseptic revision spine surgery: a systematic review and meta-analysis. Spine J. 2023;23(4):492–503. 10.1016/j.spinee.2022.10.016 . Apfel A, Lin CC, Burfeind W, Dillon MT, Navarro RA. Characteristics of Rotator Cuff Repairs Revised to Shoulder Arthroplasty. Arch Bone Jt Surg. 2020;8(5):575–80. 10.22038/abjs.2020.39006.2042 . Boileau P, Gonzalez J-F, Chuinard C, Bicknell R, Walch G. Reverse total shoulder arthroplasty after failed rotator cuff surgery. J Shoulder Elb Surg. 2009;18(4):600–6. 10.1016/j.jse.2009.03.011 . Cofield RH. Rotator cuff disease of the shoulder. J Bone Joint Surg Am. 1985;67(6):974–9. Garrigues GE, Zmistowski B, Cooper AM, Green A, Hsu J, Ricchetti E et al. Proceedings from the 2018 International Consensus Meeting on Orthopedic Infections: the definition of periprosthetic shoulder infection. Journal of Shoulder and Elbow Surgery. 2019;28(6, Supplement):S8–S12. 10.1016/j.jse.2019.04.034 Harreld KL, Puskas BL, Frankle M. Massive rotator cuff tears without arthropathy: when to consider reverse shoulder arthroplasty. J Bone Joint Surg Am. 2011;93(10):973–84. Hodakowski AJ, Cohn MR, Mehta N, Menendez ME, McCormick JR, Garrigues GE. An evidence-based approach to managing unexpected positive cultures in shoulder arthroplasty. J Shoulder Elbow Surg. 2022;31(10):2176–86. 10.1016/j.jse.2022.03.019 . Lafosse L, Brozska R, Toussaint B, Gobezie R. The Outcome and Structural Integrity of Arthroscopic Rotator Cuff Repair with Use of the Double-Row Suture Anchor Technique. JBJS. 2007;89(7):1533. 10.2106/JBJS.F.00305 . Matsen FA, Russ SM, Vu PT, Hsu JE, Lucas RM, Comstock BA. What Factors are Predictive of Patient-reported Outcomes? A Prospective Study of 337 Shoulder Arthroplasties. Clin Orthop Relat Res. 2016;474(11):2496–510. 10.1007/s11999-016-4990-1 . Purudappa PP, Sharma OP, Priyavadana S, Sambandam S, Villafuerte JA. Unexpected positive intraoperative cultures (UPIC) in revision Hip and knee arthroplasty- A review of the literature. J Orthop. 2019;17:1–6. 10.1016/j.jor.2019.06.028 . Viswanath A, Bale S, Trail I. Reverse total shoulder arthroplasty for irreparable rotator cuff tears without arthritis: A systematic review. J Clin Orthop Trauma. 2021;17:267–72. 10.1016/j.jcot.2021.04.005 . Zumstein MA, Jost B, Hempel J, Hodler J, Gerber C. The Clinical and Structural Long-Term Results of Open Repair of Massive Tears of the Rotator Cuff. JBJS. 2008;90(11):2423. 10.2106/JBJS.G.00677 . Zumstein MA, Pinedo M, Old J, Boileau P. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: A systematic review. J Shoulder Elbow Surg. 2011;20(1):146–57. 10.1016/j.jse.2010.08.001 . Tables Table I. Descriptive statistics of 92 patients with reverse total shoulder arthroplasty following ipsilateral rotator cuff repair. Age (years) 73.7 ± 7.7 Sex ratio (M/F) 0.7:1 BMI 29.7 ± 6.3 Hand Dominance Ratio (R/L) 15.6:1 Surgery Laterality Ratio (R/L) 2.6:1 Race White 89 (92.7%) Black 2 (2.1%) Unknown 5 (5.2%) Smoking Status Current 9 (9.8%) Former 39 (42.4%) Never 39 (42.4%) Unknown 5 (5.4%) Preoperative AROM Forward Elevation 99.6 ± 43.5 External Rotation 30.2 ± 20.7 Postoperative AROM Forward Elevation 143.2 ± 31.5 External Rotation 34.8 ± 15.7 Prior Ipsilateral RCR >1 prior RCR 19 (20.7%) =1 prior RCR 72 (78.3%) Unknown 1 (1.1%) Infection Status between RCR and RSA Infected 4 (4.3%) Not infected 88 (95.7%) Infection Status after RSA Infected 2 (2.2%) Unexpected positive culture 5 (5.4%) Uninfected 85 (92.4%) Table 2. Report on infected patient data. Infected Patient #1 Infected Patient #2 Age (years) 80 83 Sex M M BMI 26.3 30.6 Hand Dominance Right Right Surgery Laterality Right Right Race White White Smoking Status Former Former Preoperative AROM Forward Elevation 70 100 External Rotation 20 20 Postoperative AROM Forward Elevation 120 150 External Rotation 20 50 Prior Ipsilateral RCR >1 prior RCR 1 prior RCR Infection Status before RSA Infected Not infected Joint Aspirated pre-RSA No No CMC/CMP/PT Labs pre-RSA No No ESR/CRP Labs pre-RSA No No Cultures taken Yes (unknown quantity) No Antibiotic regiment Doxycycline, penicillin, clindamycin, augmentin, bactrim None between RSA and revision Table 3. Descriptive statistics of 5 patients with unexpected positive cultures following RSA compared to 16 patients with negative cultures following RSA. Unexpected Positive Culture (N = 5) Negative Cultures (N = 16) p-value Age (years) 70.4 ± 7.3 72.6 ± 6.5 0.46 Sex ratio (M/F) 4:1 0.8:1 0.16 Race White- 100% Black- 0% Unknown- 0% White- 100% Black- 0% Unknown- 0% >0.99 BMI 35.0 ± 5.7 30.1 ± 5.1 0.11 Hand Dominance Right- 80% Left- 0% Unknown- 20% Right- 81.3% Left- 12.5% Unknown- 6.3% 0.25 Surgery Laterality Right- 100% Left- 0% Right- 68.8% Left- 31.3% 0.28 Smoking Status Current- 20% Former- 40% Never- 40% Current- 12.5% Former- 37.5% Never- 50% 0.89 Preoperative AROM- Forward Elevation 125 ± 31.1 76.7 ± 47.4 0.05 Preoperative AROM- External Rotation 26.7 ± 5.8 34.1 ± 24.3 0.48 Postoperative AROM- Forward Elevation 133 ± 37.4 150 ± 37.8 0.26 Postoperative AROM- External Rotation 29 ± 20.1 35.9 ± 17.6 0.56 Prior Ipsilateral RCR Yes- 0% No- 100% Yes- 31.3 No- 68.8% 0.28 Infection Status pre-RSA Infected- 0% Not infected- 100% Infected- 12.5% Not infected- 87.5% >0.99 Joint Aspirated pre-RSA Yes- 20% No- 80% Yes- 12.5% No- 87.5% >0.99 CMC/CMP/PT Labs pre-RSA Labs taken- 40% No labs- 60% Labs taken- 18.8% No labs- 81.3% 0.55 ESR/CRP Labs pre-RSA Labs taken- 20% No labs- 80% Labs taken- 100% No labs- 0% 0.24 Table 4. Comparison of the number of cultures taken in the 5 unexpected positive culture patients and the 85 negative culture patients (p = 0.74). Unexpected Positive Culture (N = 5) Negative Cultures (N = 85) 1 culture– 0% 3 cultures – 20% 4 cultures – 0% 5 cultures – 0% 6 cultures – 0% 8 cultures – 20% Cultures taken (unknown quantity) – 40% 1 – 6.3% 3 cultures – 6.3% 4 cultures – 12.5% 5 cultures – 12.5% 6 cultures – 25% 8 cultures – 12.5% Cultures taken (unknown quantity) – 25% Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7551849","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":521741185,"identity":"b7ec91a9-e439-4611-b8fb-db0e6b14a0ad","order_by":0,"name":"Jacob Mogerman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIiWNgGAWjYBACxgYGBmYQg1+CgeFDBYMFiG1AnBbJGQyMM84wSBDWAgJgLQY3iNXC3H744ePCHBu7zbd7DBsO1EjIMbA3b5PA67CeNGPjmdvSkrfdOQPUckzCmIHnWBl+LQ05bNK82w4nm93IMX/8gU0isUEixwy/lv43EC3GM3KAtvwDapF/Q0DLDIgtdgYSQC0H20C28BDS8gzslwSJO8cKGw72SRiz8aQVW+DTYtifDAyxbTb2/LObNzYc+GYjx89+eOMNvFoaIHRiA0yEDZ9yEJCH0vaEFI6CUTAKRsEIBgAX1UtAI5BP3gAAAABJRU5ErkJggg==","orcid":"","institution":"University at Buffalo, University at Buffalo Jacobs School of Medicine and Biomedical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Jacob","middleName":"","lastName":"Mogerman","suffix":""},{"id":521741186,"identity":"91e5b4ef-db27-4d4b-938a-218b86e88bc4","order_by":1,"name":"Zachary Tamweber","email":"","orcid":"","institution":"University at Buffalo, University at Buffalo Jacobs School of Medicine and Biomedical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Zachary","middleName":"","lastName":"Tamweber","suffix":""},{"id":521741187,"identity":"24fffd1f-af8f-4c13-9253-fbf2c4140522","order_by":2,"name":"Lin Feng","email":"","orcid":"","institution":"UBMD Orthopaedics and Sports Medicine","correspondingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Feng","suffix":""},{"id":521741188,"identity":"c0d39ea2-f4d7-4080-9fd5-24d3ad7854f0","order_by":3,"name":"Haider Mohammed","email":"","orcid":"","institution":"UBMD Orthopaedics and Sports Medicine","correspondingAuthor":false,"prefix":"","firstName":"Haider","middleName":"","lastName":"Mohammed","suffix":""},{"id":521741189,"identity":"869706b8-15b7-4d00-87a3-0c980d9ae7fb","order_by":4,"name":"Thomas Duquin","email":"","orcid":"","institution":"UBMD Orthopaedics and Sports Medicine","correspondingAuthor":false,"prefix":"","firstName":"Thomas","middleName":"","lastName":"Duquin","suffix":""}],"badges":[],"createdAt":"2025-09-06 15:23:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7551849/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7551849/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92628985,"identity":"d860d4f4-ca03-4fdd-b519-0d5885aed7fc","added_by":"auto","created_at":"2025-10-02 02:07:00","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":37788,"visible":true,"origin":"","legend":"","description":"","filename":"P2AManuscriptJOSRSubmission.docx","url":"https://assets-eu.researchsquare.com/files/rs-7551849/v1/d5b79544acb916c51b055eaa.docx"},{"id":92628987,"identity":"641f1bac-d6bb-4591-ac1e-33d409b9b718","added_by":"auto","created_at":"2025-10-02 02:07:00","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":7292,"visible":true,"origin":"","legend":"","description":"","filename":"60b97c20072b4b64a8a73a3a6933280c.json","url":"https://assets-eu.researchsquare.com/files/rs-7551849/v1/15e981745979691398108309.json"},{"id":92628986,"identity":"3b3fac97-e4c1-43e0-bc96-d2963b95f79d","added_by":"auto","created_at":"2025-10-02 02:07:00","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":17519,"visible":true,"origin":"","legend":"","description":"","filename":"P2ATable1JOSRSubmission.docx","url":"https://assets-eu.researchsquare.com/files/rs-7551849/v1/c0eded39c6657168eff33b00.docx"},{"id":92628992,"identity":"4c10834a-e794-4c5b-b5c5-d07a09f6aef1","added_by":"auto","created_at":"2025-10-02 02:07:00","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":17371,"visible":true,"origin":"","legend":"","description":"","filename":"P2ATable2JOSRSubmission.docx","url":"https://assets-eu.researchsquare.com/files/rs-7551849/v1/545d8fec94fa0fdb63838b84.docx"},{"id":92628988,"identity":"109baedf-1d22-47dc-b800-48268f4be940","added_by":"auto","created_at":"2025-10-02 02:07:00","extension":"docx","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":18275,"visible":true,"origin":"","legend":"","description":"","filename":"P2ATable3JOSRSubmission.docx","url":"https://assets-eu.researchsquare.com/files/rs-7551849/v1/c7491ba57aa51422f631eaf2.docx"},{"id":92629288,"identity":"09745a4f-6b8e-437c-8915-35f478fa2d10","added_by":"auto","created_at":"2025-10-02 02:15:00","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":16206,"visible":true,"origin":"","legend":"","description":"","filename":"P2ATable4JOSRSubmission.docx","url":"https://assets-eu.researchsquare.com/files/rs-7551849/v1/4bc07e682a40ddbcbda37f56.docx"},{"id":92629364,"identity":"6a306114-55b5-461d-a48c-d383b67f639d","added_by":"auto","created_at":"2025-10-02 02:23:00","extension":"xml","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":43420,"visible":true,"origin":"","legend":"","description":"","filename":"60b97c20072b4b64a8a73a3a6933280c1enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7551849/v1/a82ebe0a94d5af586161c087.xml"},{"id":92628993,"identity":"4dd8ae06-1600-42ef-ad78-8989df15b0ed","added_by":"auto","created_at":"2025-10-02 02:07:00","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":40647,"visible":true,"origin":"","legend":"","description":"","filename":"60b97c20072b4b64a8a73a3a6933280c1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7551849/v1/a3f551806fc27c8a163f99c3.xml"},{"id":92628990,"identity":"1c9c9db9-d02c-4b3d-b429-08cb03ca059b","added_by":"auto","created_at":"2025-10-02 02:07:00","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":49357,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7551849/v1/78d82f88e324ed22d43d5b08.html"},{"id":92912336,"identity":"8afb0cc6-f37b-4612-b15e-2321322c08b2","added_by":"auto","created_at":"2025-10-07 04:17:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":488737,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7551849/v1/1b594faf-adb8-4746-a1fd-494865fc2ebc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Risk of Infection Following Reverse Shoulder Arthroplasty After Failed Rotator Cuff Repair: A Retrospective Review","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eRotator cuff tears are common injuries ranging from a small tear of less than 1cm to a massive tear of greater than 5cm \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Treatment of these tears most commonly consists of one or more of the following procedures: conservative non-operative/ physical therapy/ corticosteroid injection, arthroscopic debridement with the possibility of either partial repair, biceps tenotomy/ tenodesis, superior capsular repair, arthroscopic tendon transfer of latissimus dorsi or trapezius, or reverse shoulder arthroplasty (RSA). Rotator cuff repair (RCR) has historically been the primary intervention for patients who have failed non-surgical management. However, the rates of failed rotator cuff repair can range from 11%, up to 57% in some cases \u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. The management of a failed rotator cuff repair can include revision repair, superior capsule reconstruction, tendon transfers or RSA.\u003c/p\u003e\u003cp\u003eDue to the success of RSA in patients with rotator cuff arthropathy and glenohumeral arthritis, indications have expanded to include patients with irreparable rotator cuff tears or those who have failed rotator cuff repair without significant arthritis \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. While RSA is a viable and reliable secondary surgical intervention for failed rotator cuff repairs, patients who underwent arthroplasty as primary intervention instead had better overall improvement \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Demographically, patients who underwent RSA revision after initial rotator cuff repair were older and had a greater number of comorbidities. Furthermore, these patients typically required an RSA either within the first year, or greater than five years after their initial rotator cuff repair \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Currently, there is conflicting evidence regarding how previous surgery influences success of RSA \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. The global rate of complications in patients with RSA is 24%, with 3.8% of complications attributable to infection \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. However, the difference in risk of periprosthetic joint infection (PJI) between RSA as a primary or secondary surgical intervention for rotator cuff tear has yet to be explored.\u003c/p\u003e\u003cp\u003eThe objective of this study was to perform a retrospective chart review to determine if there is a significant difference in the rate of infection between patients who have failed rotator cuff repair and subsequently undergone RSA versus patients with RSA as the primary surgical intervention for their rotator cuff repair. We hypothesize that patients with ipsilateral RCR prior to RSA will have increased incidence of periprosthetic joint infection. A secondary objective of the study is to quantify and describe the incidence of unexpected positive intraoperative cultures (UPIC) in the study population.\u003c/p\u003e\u003cp\u003eUnexpected positive intraoperative cultures (UPIC) are defined as intraoperative culture results that return positive in a patient with presumed aseptic revision surgery and no signs or symptoms of infection or laboratory findings indicative of an infective process \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Hodakowski et al. reported that the prevalence of UPIC in suspected aseptic shoulder arthroplasty is up to 27.5% \u003csup\u003e7\u003c/sup\u003e. The clinical meaning of UPICs is controversial as UPICs may represent contamination of the collected samples or a low-grade sub-clinical infection. UPICs that represent true infections may have even contributed to the failure of the arthroplasty \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. While UPICs were not included in the infected group in this study, they still represent an interesting test result warranting further investigation.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003e The protocol for this retrospective chart review was reviewed and approved by the University at Buffalo IRB. All patients were seen at one large university-affiliated orthopedics and sports medicine practice.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003ePatient Population\u003c/h2\u003e\u003cp\u003eMale and female adult (\u0026ge;\u0026thinsp;18 years in age) patients were included in the analyses if they had received reverse shoulder arthroplasty following ipsilateral rotator cuff repair from January 1, 2015 \u0026ndash; July 1, 2023. Individual records were excluded if the patient did not undergo RCR prior to ipsilateral RSA or had less than 2 years of follow-up data post-RSA.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eElectronic medical records (EMR) were screened from January 1, 2015 \u0026ndash; July 1, 2023 for patients undergoing reverse shoulder arthoplasty following ipsilateral rotator cuff repair. All clinical data was extracted from the EMR, including the following clinical characteristics: age, sex, race, ethnicity, handedness, and body mass index (BMI). Extracted data was manually screened to confirm their diagnosis and treatment. All disagreements were reviewed by the senior author before excluding.\u003c/p\u003e\n\u003ch3\u003eMain Outcome Measure\u003c/h3\u003e\n\u003cp\u003eInfection was defined using the criteria outlined during 2018 International Meeting on Orthopedic Infections. A definite PJI was defined as meeting one or more of the following three criteria: presence of a sinus tract, gross intra-articular pos, and/ or two positive tissue cultures with a phenotypically identical virulent organism \u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. The incidence rate of infection following RSA in the sample population was compared to the global rate of infection using a one sample binomial test.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eUnivariate statistics for the entire sample were calculated. Patients with definitive PJI were identified and an incidence rate was calculated by dividing the number of definite cultures by the total sample size. In those PJI negative patients with cultures, we compared those that had negative and unexpected positive cultures. A z-test of proportion was used to compare incidence of unexpected positive results to a previously published rate of 17%. Number of times cultures were calculated and compared. Due to the small sample sizes, a Mann Whitney U test was used to compare continuous variables and a Chi-squared test was used for categorical outcomes. A p-value of \u0026lt;\u0026thinsp;.05 is considered statistically significant. All statistical analysis was performed using SPSS Version 29.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eOf the 92 patients who met the inclusion criteria, 64 were male and 28 were female, with an average BMI of 29.7\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3. Other descriptive statistics for the study population are included in table 1.\u003c/p\u003e\u003cp\u003eTwo patients met the criteria for definite periprosthetic joint infection (2.2%). The 2.2% incidence of PJI in our study population of patients with RSA following ipsilateral RCR is not significantly different from the 3.8% general incidence of infection following RSA (p\u0026thinsp;=\u0026thinsp;0.294). Meaningful statistical differences between the infected group (n\u0026thinsp;=\u0026thinsp;2) and uninfected group (n\u0026thinsp;=\u0026thinsp;90) were limited by the small sample size. Instead, a description of infected patient data is included in table 2. Infected patient #1 did not undergo revision RSA for periprosthetic joint infection. Infected patient #2 underwent revision RSA with simultaneous washout.\u003c/p\u003e\u003cp\u003eOf the remaining 90 patients without definite periprosthetic joint infection, 21 patients had at least one intraoperative culture at the time of their RSA due to clinical suspicion of shoulder infection. 5 of these 21 patients had unexpected positive intraoperative cultures (23.8%). All patients with UPIC were infected with \u003cem\u003eProprioni acnes\u003c/em\u003e, a nonvirulent organism. Infection via a nonvirulent organism without other signs of gross infection prevented the group from fulfilling PJI criteria.\u003c/p\u003e\u003cp\u003ePatients in the unexpected positive intraoperative culture (UPIC) group had a significantly higher preoperative active range of forward elevation (p\u0026thinsp;=\u0026thinsp;.05) compared to the negative culture group. There were no other significant differences between the two groups for all other study parameters. The number of intraoperative cultures collected in the UPIC group did not differ significantly from the negative culture groups.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eContrary to the study hypothesis, there is no statistically significant difference between the rate of infection in patients following RSA with prior ipsilateral RCR and the established rate of infection following RSA (p\u0026thinsp;=\u0026thinsp;0.294). These results align with the current treatment algorithm, which recommends RCR as the primary surgical intervention, reserving RSA for salvage procedures. This is not to say that RSA is an inappropriate primary intervention in all patients; however, given that RCR is less invasive than RSA and generally confers greater postoperative range of motion, patients may elect to attempt RCR first. This is especially true in younger patients who may expect a greater return to baseline after surgery.\u003c/p\u003e\u003cp\u003eThe variability in the number of intraoperative cultures drawn during RSA in patients with prior RCR observed in this study led to discussion on culture protocol for shoulder reoperations.\u003c/p\u003e\u003cp\u003e Intraoperative cultures for open shoulder surgery yield a 17% false-positive rate, and current guidelines recommend collecting a minimum of 3, but ideally 5 to 6, cultures. In addition to testing errors, patients without clinically significant signs of infection may test positive for nonvirulent organisms, such as those infected with \u003cem\u003eP. acnes\u003c/em\u003e in this study. Increasing the number of cultures drawn increases risk of false-positive test results and the risk of unexpected positive cultures in patients without signs of infection. Therefore, future studies should aim to standardize intraoperative protocols for this patient population such that definite periprosthetic joint infections can be identified in the fewest number of cultures possible.\u003c/p\u003e\u003cp\u003eAdditionally, there is a need for future work to standardize antibiotic regiments for patients with unexpected positive cultures, particularly for non-virulent organisms such as \u003cem\u003eP. acnes\u003c/em\u003e. The combination of an appropriate intraoperative culture protocol and a standardized antibiotic course for patients with unexpected positive intraoperative cultures may confer fewer shoulder reoperations and improved patient outcomes. As a secondary benefit, defined indications and outlines can help reduce antibiotic overuse and the development of antibiotic-resistant organisms.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eElecting to undergo RSA as the primary surgical intervention in the management of rotator cuff tear does not confer decreased risk of infection. The similar rates of infection between RSA as primary or secondary surgical intervention suggests that RCR is still an appropriate primary surgical intervention.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCOI\u003c/strong\u003e: The authors above declares that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: None\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eJacob Mogerman, BS \u0026ndash; JM- Methodology, Conceptualization, Writing \u0026ndash; Review \u0026amp; Editing\u003c/li\u003e\n \u003cli\u003eZachary Tamweber, BS \u0026ndash; ZT- Methodology, Conceptualization, Writing \u0026ndash; Review \u0026amp; Editing\u003c/li\u003e\n \u003cli\u003eLin Feng, MS \u0026ndash; LF- Project Administration\u003c/li\u003e\n \u003cli\u003eM. Nadir Haider, MD, PhD- NH- Analysis\u003c/li\u003e\n \u003cli\u003eThomas Duquin, MD- TD- Validation, Supervision\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eIRB Approval\u003c/strong\u003e: STUDY00007950 approved on 12/14/2023\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAldahamsheh O, Burger LD, Evaniew N, Swamy G, Jacobs WB, Thomas KC, et al. Unexpected intraoperative positive culture (UIPC) in presumed aseptic revision spine surgery: a systematic review and meta-analysis. Spine J. 2023;23(4):492\u0026ndash;503. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.spinee.2022.10.016\u003c/span\u003e\u003cspan address=\"10.1016/j.spinee.2022.10.016\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eApfel A, Lin CC, Burfeind W, Dillon MT, Navarro RA. Characteristics of Rotator Cuff Repairs Revised to Shoulder Arthroplasty. Arch Bone Jt Surg. 2020;8(5):575\u0026ndash;80. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.22038/abjs.2020.39006.2042\u003c/span\u003e\u003cspan address=\"10.22038/abjs.2020.39006.2042\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBoileau P, Gonzalez J-F, Chuinard C, Bicknell R, Walch G. Reverse total shoulder arthroplasty after failed rotator cuff surgery. J Shoulder Elb Surg. 2009;18(4):600\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jse.2009.03.011\u003c/span\u003e\u003cspan address=\"10.1016/j.jse.2009.03.011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCofield RH. Rotator cuff disease of the shoulder. J Bone Joint Surg Am. 1985;67(6):974\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGarrigues GE, Zmistowski B, Cooper AM, Green A, Hsu J, Ricchetti E et al. Proceedings from the 2018 International Consensus Meeting on Orthopedic Infections: the definition of periprosthetic shoulder infection. Journal of Shoulder and Elbow Surgery. 2019;28(6, Supplement):S8\u0026ndash;S12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jse.2019.04.034\u003c/span\u003e\u003cspan address=\"10.1016/j.jse.2019.04.034\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHarreld KL, Puskas BL, Frankle M. Massive rotator cuff tears without arthropathy: when to consider reverse shoulder arthroplasty. J Bone Joint Surg Am. 2011;93(10):973\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHodakowski AJ, Cohn MR, Mehta N, Menendez ME, McCormick JR, Garrigues GE. An evidence-based approach to managing unexpected positive cultures in shoulder arthroplasty. J Shoulder Elbow Surg. 2022;31(10):2176\u0026ndash;86. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jse.2022.03.019\u003c/span\u003e\u003cspan address=\"10.1016/j.jse.2022.03.019\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLafosse L, Brozska R, Toussaint B, Gobezie R. The Outcome and Structural Integrity of Arthroscopic Rotator Cuff Repair with Use of the Double-Row Suture Anchor Technique. JBJS. 2007;89(7):1533. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2106/JBJS.F.00305\u003c/span\u003e\u003cspan address=\"10.2106/JBJS.F.00305\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMatsen FA, Russ SM, Vu PT, Hsu JE, Lucas RM, Comstock BA. What Factors are Predictive of Patient-reported Outcomes? A Prospective Study of 337 Shoulder Arthroplasties. Clin Orthop Relat Res. 2016;474(11):2496\u0026ndash;510. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11999-016-4990-1\u003c/span\u003e\u003cspan address=\"10.1007/s11999-016-4990-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePurudappa PP, Sharma OP, Priyavadana S, Sambandam S, Villafuerte JA. Unexpected positive intraoperative cultures (UPIC) in revision Hip and knee arthroplasty- A review of the literature. J Orthop. 2019;17:1\u0026ndash;6. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jor.2019.06.028\u003c/span\u003e\u003cspan address=\"10.1016/j.jor.2019.06.028\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eViswanath A, Bale S, Trail I. Reverse total shoulder arthroplasty for irreparable rotator cuff tears without arthritis: A systematic review. J Clin Orthop Trauma. 2021;17:267\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jcot.2021.04.005\u003c/span\u003e\u003cspan address=\"10.1016/j.jcot.2021.04.005\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZumstein MA, Jost B, Hempel J, Hodler J, Gerber C. The Clinical and Structural Long-Term Results of Open Repair of Massive Tears of the Rotator Cuff. JBJS. 2008;90(11):2423. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2106/JBJS.G.00677\u003c/span\u003e\u003cspan address=\"10.2106/JBJS.G.00677\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZumstein MA, Pinedo M, Old J, Boileau P. Problems, complications, reoperations, and revisions in reverse total shoulder arthroplasty: A systematic review. J Shoulder Elbow Surg. 2011;20(1):146\u0026ndash;57. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jse.2010.08.001\u003c/span\u003e\u003cspan address=\"10.1016/j.jse.2010.08.001\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable I. Descriptive statistics of 92 patients with reverse total shoulder arthroplasty following ipsilateral rotator cuff repair.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"623\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e73.7 \u0026plusmn; 7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003eSex ratio (M/F)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e0.7:1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003eBMI\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e29.7 \u0026plusmn; 6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003eHand Dominance Ratio (R/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e15.6:1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003eSurgery Laterality Ratio (R/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e2.6:1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003eRace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; White\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e89 (92.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Black\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e2 (2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e5 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003eSmoking Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Current\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e9 (9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Former\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e39 (42.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Never\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e39 (42.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e5 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003ePreoperative AROM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Forward Elevation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e99.6 \u0026plusmn; 43.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; External Rotation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e30.2 \u0026plusmn; 20.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003ePostoperative AROM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Forward Elevation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e143.2 \u0026plusmn; 31.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; External Rotation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e34.8 \u0026plusmn; 15.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003ePrior Ipsilateral RCR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026gt;1 prior RCR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e19 (20.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; =1 prior RCR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e72 (78.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Unknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e1 (1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003eInfection Status between RCR and RSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Infected\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e4 (4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Not infected\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e88 (95.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003eInfection Status after RSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Infected\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e2 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Unexpected positive culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e5 (5.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 49.4382%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Uninfected\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50.5618%;\"\u003e\n \u003cp\u003e85 (92.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Report on infected patient data.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eInfected Patient #1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003eInfected Patient #2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eSex\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eBMI\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003e26.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003e30.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eHand Dominance\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eSurgery Laterality\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eRace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003eWhite\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eSmoking Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eFormer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003eFormer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003ePreoperative AROM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Forward Elevation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; External Rotation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003ePostoperative AROM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Forward Elevation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003e150\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; External Rotation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003ePrior Ipsilateral RCR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003e\u0026gt;1 prior RCR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003e1 prior RCR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eInfection Status before RSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eInfected\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003eNot infected\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eJoint Aspirated pre-RSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eCMC/CMP/PT Labs pre-RSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eESR/CRP Labs pre-RSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eCultures taken\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eYes (unknown quantity)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eAntibiotic regiment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.9936%;\"\u003e\n \u003cp\u003eDoxycycline, penicillin, clindamycin, augmentin, bactrim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 36.0129%;\"\u003e\n \u003cp\u003eNone between RSA and revision\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 3. Descriptive statistics of 5 patients with unexpected positive cultures following RSA compared to 16 patients with negative cultures following RSA.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.7428%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5113%;\"\u003e\n \u003cp\u003eUnexpected Positive Culture\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(N = 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9743%;\"\u003e\n \u003cp\u003eNegative Cultures\u003c/p\u003e\n \u003cp\u003e(N = 16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.7428%;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5113%;\"\u003e\n \u003cp\u003e70.4 \u0026plusmn; 7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9743%;\"\u003e\n \u003cp\u003e72.6 \u0026plusmn; 6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.7428%;\"\u003e\n \u003cp\u003eSex ratio (M/F)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5113%;\"\u003e\n \u003cp\u003e4:1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9743%;\"\u003e\n \u003cp\u003e0.8:1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.7428%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRace\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5113%;\"\u003e\n \u003cp\u003eWhite- 100%\u003c/p\u003e\n \u003cp\u003eBlack- 0%\u003c/p\u003e\n \u003cp\u003eUnknown- 0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9743%;\"\u003e\n \u003cp\u003eWhite- 100%\u003c/p\u003e\n \u003cp\u003eBlack- 0%\u003c/p\u003e\n \u003cp\u003eUnknown- 0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.7428%;\"\u003e\n \u003cp\u003eBMI\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5113%;\"\u003e\n \u003cp\u003e35.0 \u0026plusmn; 5.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9743%;\"\u003e\n \u003cp\u003e30.1 \u0026plusmn; 5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.7428%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHand Dominance\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5113%;\"\u003e\n \u003cp\u003eRight- 80%\u003c/p\u003e\n \u003cp\u003eLeft- 0%\u003c/p\u003e\n \u003cp\u003eUnknown- 20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9743%;\"\u003e\n \u003cp\u003eRight- 81.3%\u003c/p\u003e\n \u003cp\u003eLeft- 12.5%\u003c/p\u003e\n \u003cp\u003eUnknown- 6.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.7428%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSurgery Laterality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5113%;\"\u003e\n \u003cp\u003eRight- 100%\u003c/p\u003e\n \u003cp\u003eLeft- 0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9743%;\"\u003e\n \u003cp\u003eRight- 68.8%\u003c/p\u003e\n \u003cp\u003eLeft- 31.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.7428%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSmoking Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5113%;\"\u003e\n \u003cp\u003eCurrent- 20%\u003c/p\u003e\n \u003cp\u003eFormer- 40%\u003c/p\u003e\n \u003cp\u003eNever- 40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9743%;\"\u003e\n \u003cp\u003eCurrent- 12.5%\u003c/p\u003e\n \u003cp\u003eFormer- 37.5%\u003c/p\u003e\n \u003cp\u003eNever- 50%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.7428%;\"\u003e\n \u003cp\u003ePreoperative AROM- \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Forward Elevation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5113%;\"\u003e\n \u003cp\u003e125 \u0026plusmn; 31.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9743%;\"\u003e\n \u003cp\u003e76.7 \u0026plusmn;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e47.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.7428%;\"\u003e\n \u003cp\u003ePreoperative AROM-\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; External Rotation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5113%;\"\u003e\n \u003cp\u003e26.7 \u0026plusmn; 5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9743%;\"\u003e\n \u003cp\u003e34.1 \u0026plusmn; 24.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.7428%;\"\u003e\n \u003cp\u003ePostoperative AROM-\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Forward Elevation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5113%;\"\u003e\n \u003cp\u003e133 \u0026plusmn; 37.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9743%;\"\u003e\n \u003cp\u003e150 \u0026plusmn; 37.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.7428%;\"\u003e\n \u003cp\u003ePostoperative AROM-\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; External Rotation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5113%;\"\u003e\n \u003cp\u003e29 \u0026plusmn; 20.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9743%;\"\u003e\n \u003cp\u003e35.9 \u0026plusmn; 17.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.7428%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePrior Ipsilateral RCR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5113%;\"\u003e\n \u003cp\u003eYes- 0%\u003c/p\u003e\n \u003cp\u003eNo- 100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9743%;\"\u003e\n \u003cp\u003eYes- 31.3\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNo- 68.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.7428%;\"\u003e\n \u003cp\u003eInfection Status pre-RSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5113%;\"\u003e\n \u003cp\u003eInfected- 0%\u003c/p\u003e\n \u003cp\u003eNot infected- 100%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9743%;\"\u003e\n \u003cp\u003eInfected- 12.5%\u003c/p\u003e\n \u003cp\u003eNot infected- 87.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.7428%;\"\u003e\n \u003cp\u003eJoint Aspirated pre-RSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5113%;\"\u003e\n \u003cp\u003eYes- 20%\u003c/p\u003e\n \u003cp\u003eNo- 80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9743%;\"\u003e\n \u003cp\u003eYes- 12.5%\u003c/p\u003e\n \u003cp\u003eNo- 87.5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e\u0026gt;0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.7428%;\"\u003e\n \u003cp\u003eCMC/CMP/PT Labs pre-RSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5113%;\"\u003e\n \u003cp\u003eLabs taken- 40%\u003c/p\u003e\n \u003cp\u003eNo labs- 60%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9743%;\"\u003e\n \u003cp\u003eLabs taken- 18.8%\u003c/p\u003e\n \u003cp\u003eNo labs- 81.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.7428%;\"\u003e\n \u003cp\u003eESR/CRP Labs pre-RSA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 31.5113%;\"\u003e\n \u003cp\u003eLabs taken- 20%\u003c/p\u003e\n \u003cp\u003eNo labs- 80%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.9743%;\"\u003e\n \u003cp\u003eLabs taken- 100%\u003c/p\u003e\n \u003cp\u003eNo labs- 0%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 10.7717%;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 4. Comparison of the number of cultures taken in the 5 unexpected positive culture patients and the 85 negative culture patients (p = 0.74).\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eUnexpected Positive Culture (N = 5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eNegative Cultures (N = 85)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e1 culture\u0026ndash; 0%\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 cultures \u0026ndash; 20%\u003c/p\u003e\n \u003cp\u003e4 cultures \u0026ndash; 0%\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 cultures \u0026ndash; 0%\u003c/p\u003e\n \u003cp\u003e6 cultures \u0026ndash; 0%\u003c/p\u003e\n \u003cp\u003e8 cultures \u0026ndash; 20%\u003c/p\u003e\n \u003cp\u003eCultures taken (unknown quantity) \u0026ndash; 40%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e1 \u0026ndash; 6.3%\u003c/p\u003e\n \u003cp\u003e3 cultures \u0026ndash; 6.3%\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4 cultures \u0026ndash; 12.5%\u003c/p\u003e\n \u003cp\u003e5 cultures \u0026ndash; 12.5%\u003c/p\u003e\n \u003cp\u003e6 cultures \u0026ndash; 25%\u003c/p\u003e\n \u003cp\u003e8 cultures \u0026ndash; 12.5%\u003c/p\u003e\n \u003cp\u003eCultures taken (unknown quantity) \u0026ndash; 25%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Rotator Cuff Repair (RCR), Reverse Shoulder Arthroplasty (RSA), Periprosthetic Joint Infection (PJI), Unexpected Positive Intra-operative Cultures (UPC), Ipsilateral Shoulder Surgery","lastPublishedDoi":"10.21203/rs.3.rs-7551849/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7551849/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction \u003c/strong\u003eRotator cuff repair (RCR) is a treatment option for rotator cuff tear, but the failure rate is 11-57%, requiring reverse shoulder arthroplasty (RSA). Due to its success, indications for RSA have expanded to include patients who failed RCR without significant arthritis. Periprosthetic joint infection (PJI) rate after RSA (with prior RCR or not) is 2.4% and unexpected positive intra-operative cultures (UPIC) is 17%.. This study aims to identify infection rates in a historic cohort undergoing RSA who previously had an RCR. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaterial and Methods\u003c/strong\u003e Medical records between 2015-2023 from one university hospital were screened\u0026nbsp; for\u0026nbsp; adult patients undergoing RSA for rotator cuff tear who have previously undergone ipsilateral RCR. Intraoperative samples were obtained in patients at high risk of PJI. PJI and UPIC rates were calculated and compared to the population norm using one-sample proportion test. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003eDuring enrollment period, 92 patients (73.9 years, 42% male, 29.7kgm-2) met inclusion criteria and cultures were obtained from 23 high risk patients (72.1 years, 52% male, 31.1kgm-2). Two PJI were identified (80 y/o M and 83 y/o M), which corresponds to a PJI rate of 2.2%, which is not significantly different than the population norm. Of the remaining 21 cultures, 5 (23.8%) were UPIC of P. acnes, which was also not different. Minimal demographic or clinical differences were observed between those that had a negative culture and those that had UPIC. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiscussion \u003c/strong\u003eOur study found no increase in PJI or UPIC in patients undergoing RSA following ipsilateral RCR compared to previous reports on the general risk of infection for RSA alone. Although not the primary aim, the 23.8% incidence of UPIC in patients with suspected PJI is higher than the population norm of 17%.\u0026nbsp; While this result was not statistically significant, it prompts discussion on developing guidelines for intraoperative culture sampling specific to patients with multiple ipsilateral shoulder surgeries. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLevel of Evidence: Level III- Retrospective Cohort Study\u003c/p\u003e","manuscriptTitle":"Risk of Infection Following Reverse Shoulder Arthroplasty After Failed Rotator Cuff Repair: A Retrospective Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-02 02:06:55","doi":"10.21203/rs.3.rs-7551849/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0231550f-72aa-46bb-9e2d-bed89c4e8e28","owner":[],"postedDate":"October 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-07T04:08:55+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-02 02:06:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7551849","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7551849","identity":"rs-7551849","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}