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  • Interested in the Reading Shoulder fellowship?
    a post-CCT shoulder fellowship for One year. please send CV to Mrs Jan Barker [Read more]
  • Applications for the Senior shoulder fellowship starting in July 2014 is now open.
    Please apply electronically through NHS Jobs
    Visits to the Reading shoulder unit are welcome - Please liaise with Jan Barker [Read more]
  • New, New, New: Innovative Design Orthopaedics -
    IDO Isometer Shoulder Muscle Strength Gauge. [Read more]
  • Verso Stemless TSA with a new company Innovative Design Orthopaedics (IDO)
  • Coming up courses:
    Following a very successful course in July we invite you to join the 

    Reading Shoulder Arthroplasty Instructional course 7 November 2014


    Limited places - Register early [Read more]
  • Physiotherapists interested in shoulder surgery are invited to the Reading Advanced Shoulder course 2013 with outstanding international faculty. [Read more]
  • For GPs - New!!! NHS Choose & Book
    The Unit at Berkshire Independent Hospital is open for NHS patients through Choose & Book (Extended Choice Network).
    Book online
    or contact the secretaries. [Read more]
  • The unit is recognised worldwide, treating patients locally
  • Groundbreaking research from the Reading Shoulder Unit by Prof. Ofer Levy and his team regarding Propionibacterium Acnes and shoulder arthritis. 
    Propionibacterium acnes: an underestimated etiology in the pathogenesis of osteoarthritis?

    This is a very important article in that it suggests the presence of propionibacterium in previously unoperated shoulders with arthritis and furthermore that 'aseptic' failures of shoulder arthroplasty may, in fact, be related to indolent infections with this slow growing organism.
    Read comments by Dr Frederick A. Matsen III, M.D.
    [Read more]
  • New Survey on usage of shoulder replacement prostheses.
    Take the survey [Read more]
  • Listen to the BBC Radio4 programme - a day in the operating theatre at the Reading Shoulder Unit at the Royal Berkshire Hospital - Case Notes with Dr Mark Porter on Regional anaesthesia for shoulder surgery [Read more]
Propionibacterium acnes: an underestimated etiology in the pathogenesis of osteoarthritis?

 

Background: Propionibacterium acnes is a common pathogen in infections after shoulder surgery. Recent reports found positive Pacnes cultures in a high percentage of patients who had revision shoulder arthroplasty for ‘‘aseptic loosening’’ without any overt signs of infection. Isolation of P acnes is difficult, and by use of conventional microbiological protocols of 48-hour incubation, a considerable proportion of patients with possible P acnes infection may remain unidentified. 

We recently noted P acnes in shoulder joint cultures in patients undergoing primary shoulder replacement for glenohumeral arthropathy without any signs of infection.

Methods: We collected aspirates and biopsy specimens from 55 consecutive patients with arthritic shoulders undergoing primary joint replacement and examined them for the presence of P acnes. Special measures were taken to ensure that the specimens were carefully taken from within the joint to reduce the risk of contamination to minimal.

Results: In 23 of 55 consecutive patients (41.8%) undergoing primary shoulder joint replacement, P acnes was found in the joint fluid and tissues taken before the insertion of the implants. All these patients were treated early postoperatively with pathogen-directed specific dual oral antibiotic treatment for 4 weeks. In none have any signs of infection developed.

Discussion and conclusion: This finding of a high incidence of P acnes in joints before arthroplasty may suggest a role of P acnes in the pathogenesis of glenohumeral arthropathy. In addition, it raises the question of whether development of painful joint replacement later on and presumed aseptic loosening do, in fact, comprise an unrecognized low-grade infection that has been present since before the index operation. 

Level of evidence: Level IV, Case Series, Prognosis Study.

2013 Journal of Shoulder and Elbow Surgery Board of Trustees.

Keywords: Propionibacterium acnes; P acnes; infection; osteoarthritis; glenohumeral arthropathy; primary

shoulder arthroplasty; aseptic loosening; joint replacement

(J Shoulder Elbow Surg (2013) 22, 505-511)