Diagnosing a periprosthetic shoulder infection: A systematic review.

INTRODUCTION: The aim of this study was to systematically review the literature regarding accurate shoulder prosthetic joint infection (PJI) diagnosis. METHODS: Using PRISMA guidelines, we analyzed 25 studies reporting on 5535 patients and 646 infections. RESULTS: Cutibacterium acnes (C. acnes) cultures were positive in 60% of patients. Serum markers WBC, CRP, ESR, and IL-6 appear to lack diagnostic reliability. Synovial IL-6 and alpha-defensin may be more accurate in detecting infections. CONCLUSION: Synovial IL-6 and alpha-defensin appear to have greater utility than serum markers. These may be incorporated into new criteria to accurately diagnose shoulder PJI. LEVEL OF EVIDENCE: IV.