Management of Cutibacterium acnes and total shoulder arthroplasty: has consensus been achieved?

Background: Periprosthetic shoulder infection remains a difficult complication to identify and treat. In efforts to improve provide clarity, a subgroup of the Second International Consensus Meeting on Musculoskeletal Infection (ICM) generated over 70 recommendations. To understand the current treatment practices and impact of the ICM's work, a survey of shoulder arthroplasty providers was performed. Methods: A 22-question survey, consisting of questions based upon the ICM consensus statement and the clinical experience of these authors, was distributed to all active members of the American Shoulder and Elbow Surgeons. Questions regarded the work-up, diagnosis, and treatment of periprosthetic shoulder infection—with specific attention to Cutibacterium acnes. Results: One hundred fifty-nine members completed the survey (16%; 159/990) between August 8 and October 18, 2019. Only two-thirds of respondents reported utilizing the definition of periprosthetic shoulder infection proposed by the ICM subgroup. The survey results and associated literature review provided here demonstrate continued discordance regarding the diagnostic work-up and treatment of periprosthetic shoulder infection. Conclusion: It is imperative that the shoulder arthroplasty community adopts a uniform definition for periprosthetic shoulder infection as well as a multispecialty team-based approach to improve patient care and better focus future research. Level of Evidence: Level IV; Survey Study; Case Series