Editorial Commentary : Orthopaedic Shoulder Surgeons Should Have Greater Awareness of Cutibacterium acnes Subclinical Infection in the Arthroscopic Postoperative Patient who Presents With Pain and Stiffness

While hopefully it is not a frequent issue in most arthroscopic shoulder surgeons' practice, postoperative patients do return to clinic with pain and stiffness. In most cases, initial evaluation and assessment may point to an etiology of increased postoperative scar tissue, possibly as far as an adhesive capsulitis as the source with patient noncompliance of the postoperative protocol or therapy. In this patient, with limited clinical signs, does the surgeon consider infection and more specifically infection with Cutibacterium acnes? C. acnes part of the normal skin flora and is associated with orthopaedic joint infection. Most of the time, an infection with C. acnes is very subtle as it does not present with the classic infective symptoms (fever, purulence, sepsis, etc.). Maybe orthopaedic surgeons should be more aware of the possibility of a subclinical C. acnes infection in a patient with a painful, stiff joint after arthroscopic shoulder stabilization surgery. If the patient is to require revision surgery, it is advisable to take cultures to identify if there is a presence of C. acnes (or other bacteria).