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Objectives and questions: Periprosthetic joint infection is a rare but serious complication after shoulder arthroplasty, often requiring surgical revision. Reported incidence ranges from 0.4% to 2% after primary shoulder arthroplasty and around 1% to 5% after revision shoulder arthroplasty. This analysis aimed to 1) determine the incidence of infections requiring revision and 2) develop a logistic regression model to identify associated risk factors in a local shoulder arthroplasty registry.

Material and methods: All arthroplasties from a local shoulder arthroplasty registry that required revision due to infection between 2006 and 2025 were extracted. A logistic regression model was developed using the presence of infection requiring revision surgery as the dependent variable and age at surgery, sex, ASA risk categorization, type of arthroplasty (anatomic or reverse), and whether it was a revision procedure as independent variables.

Results: Among 4070 cases in the registry, 88% (3580) were primary and 12% (490) were revision arthroplasties. Mean age at surgery was 71 years, with 64% of patients being female. The main indication was cuff tear arthropathy (44%, 1,716 cases), followed by primary osteoarthritis (27%, 1,040 cases). Among primary arthroplasties, 24% (870) were anatomic and 76% (2,710) reverse shoulder arthroplasties. Revision procedures were similar, with 26% (126) anatomic, 73% (357) reverse, and 1% (7) performed as girdlestone procedures. The overall incidence of infection requiring revision was 0.76%. Stratified by procedure type, incidence was 0.34% for primary anatomic shoulder arthroplasty, 0.66% for primary reverse shoulder arthroplasty, and 2.1% for revision arthroplasties. Logistic regression identified age (OR: -0.04 [-0.07; -0.01], p=0.025), male sex (OR: 1.1 [0.37; 1.91], p=0.004), and revision arthroplasty (OR: 1.08 [0.30; 1.85], p=0.007) as significant factors associated with infection.

Discussion and conclusions: Consistent with prior reports, the results show increased likelihood of infection associated with younger age, male sex, and revision procedures. The low overall incidence of infections is attributed to the predominantly elective nature of surgeries in this cohort, as well as the implementation of a comprehensive anti-infectious protocol, which minimizes exposure to pathogens and reduces the risk of contamination at the surgical site.