Never Too Old for Arthroscopic Surgery: Woman with Low Virulence Pathogenic Shoulder Osteomyelitis - A Case Report

Summary

This study aims to demonstrate the arthroscopic management of post-operative shoulder osteomyelitis in an elderly patient, highlighting this minimally invasive approach, combined with targeted antibiotics, as an effective treatment strategy for such complex infections.

Abstract

The incidence of advanced osteomyelitis following arthroscopic shoulder surgery is rare, with few documented cases. As the need for shoulder interventions in elderly populations increases, managing these complex infections poses a significant surgical challenge. This report details the case of an 85-year-old woman who presented with fever and a fistulating portal site infection of the right shoulder. Diagnostic workup confirmed methicillin-resistant Staphylococcus aureus (MRSA). She was successfully treated with arthroscopic irrigation, debridement, and synovectomy, followed by a three-month course of oral antibiotics. At follow-up visits between three and six months, there was no clinical or laboratory evidence of recurrent infection. Osteomyelitis or septic arthritis of the shoulder, whether spontaneous or iatrogenic, is a severe complication risking joint destruction and permanent dysfunction. This case demonstrates that arthroscopic decompression combined with targeted systemic antibiotic therapy is an effective management strategy. Repeat lavage should be considered if symptoms persist, offering a viable approach to achieve infection control and preserve shoulder function in elderly patients.

Introduction

This is the first documented case of post-operative shoulder osteomyelitis caused by a low-virulence pathogen in an elderly patient, demonstrating the value of arthroscopic technique for this condition. Despite centenarians (individuals aged over 100) being ordinary, this population is still growing headlong. It is estimated that the proportion of the elderly in various regions will reach 28% in 2050, while the elderly population in China already accounts for 12.5%, and the number of people over the age of 80 has reached 19 million¹. In the wake of the number of centenarians expected to increase significantly in the next few years, the need for....

Protocol

This study was approved by the Human Ethics Committee of The First Affiliated Hospital, School of Medicine, Zhejiang University. The reagents and the equipment used are listed in the Table of Materials.

1. Pre-operative assessment and preparation

1. Diagnostic confirmation: The diagnosis of osteomyelitis was confirmed via the steps below:
   1. Pre-operative MRI findings consistent with joint abscess, bony destruction, and intraosseous signal changes (Figure 3).
   2. Diagnostic arthrocentesis yielded purulent fluid with a synovial fluid glucose lev....

Results

Post-operative findings
Pseudomembranous tissue was observed on the head and shaft of the humerus during the operation, and there was evidence of shoulder joint infection with an intra-humerus lesion. In combination with the patient's etiology results, sensitive antibiotics were used for anti-infection treatment, including vancomycin and synthetic antibiotics. Vancomycin (1000 mg, Q12h) and moxifloxacin (300 mg, QD-IVGT) were used for 3 days after surgery. Then vancomycin (500 mg, Q12h) and rifampici.......

Discussion

Septic arthritis and osteomyelitis of the shoulder are rare but devastating complications following arthroscopic surgery, with reported incidences below 1%. Table 4 provides a literature review of documented or presumed cases of shoulder infection or osteomyelitis. The past reports of open proximal humerus fractures date back to 1907 by Keen²⁷. Open reduction and internal fixation of proximal humerus fracture remained the standard surgical treatment up to now, whe.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Arthroscopic equipment	Smith&Nephew Company, US	REF3894	A device that uses a small camera and light source to visualize the internal structures of a joint. It is typically used alongside a series of some instruments and tools to perform surgery or examinations.
Clinical bacterial culture identification reagent	BioMérieux Company, France	CN2050025	micrococcus identification kit
MRI equipment	GE Company, US	SIGNA Voyager 3.0T	By applying an external gradient magnetic field to detect the emitted electromagnetic waves, the positions and types of atomic nuclei within an object can be determined, based on which an internal structural image of the object can be created.
Vancocin (medicine)	Edding Group Company	H20140174	500mg/bottle
X ray equipment	GE Company, US	Discovery XR656 Plus	A commonly used medical imaging technique that generates images of internal structures of the body, particularly bones and certain organs, by using low doses of radiation.