Detritic synovitis can mimic a Propionibacterium periprosthetic infection

Int Orthop. 2016 Jan;40(1):95-8. doi: 10.1007/s00264-015-3032-z. Epub 2015 Nov 10.


Purpose: The purpose of this article is to illustrate that the clinical findings of detritic synovitis complicating a total shoulder arthroplasty can strongly resemble those of a 'stealth' periprosthetic shoulder infection with a low-virulence organism such as Propionibacterium.

Methods: We present a review of the literature and illustrate an example of detritic synovitis following a total shoulder arthroplasty.

Results: The combination of glenoid component loosening and humeral osteolysis after total shoulder arthroplasty are commonly attributed to periprosthetic infection with low virulence organisms, such as Propionibacterium or coagulase negative Staphylococcus. Such a periprosthetic infection can appear long after the index joint replacement. This article points out that these same findings may occur with a non-infectious process initiated by polyethylene, cement or metal debris-detritic synovitis.

Conclusions: At present, the important differentiation between these two etiologies can only be ascertained by awaiting the results of cultures obtained at the time of revision surgery.

Keywords: Detritic synovitis; Osteolysis; Periprosthetic shoulder infection; Total shoulder failure.

Publication types

  • Review

MeSH terms

  • Arthroplasty, Replacement / adverse effects*
  • Arthroplasty, Replacement / methods
  • Diagnosis, Differential
  • Gram-Positive Bacterial Infections / diagnosis*
  • Humans
  • Propionibacterium / isolation & purification*
  • Prosthesis-Related Infections / diagnosis*
  • Reoperation / methods
  • Shoulder Joint / pathology
  • Shoulder Joint / surgery*
  • Synovitis / diagnosis*
  • Synovitis / etiology
  • Treatment Outcome