Journal Article

Intraoperative Intra-articular Antibiotic Injection Reduces Infection in Shoulder Arthroplasty

Wiesel, Brent B., Lovallo, Jeffrey L., Murray, Ryan S., Curley, Andrew J., Conroy, Christine M., Johnson, Douglass C.

2023

Overview

Deep infection is a debilitating complication after shoulder arthroplasty. The authors hypothesized that an intra-articular, intraoperative injection of antibiotics would result in a lower infection rate compared with intravenous antibiotics alone. Before 2007, 164 patients (group A) did not receive intra-articular antibiotics. From 2007 to 2018, 1324 patients (group B) received intra-articular antibiotics. Patients received intra-articular gentamicin at the end of surgery with the addition of 1 g of cefazolin in January 2014. Records were retrospectively reviewed for comorbidities, type of surgery, and infection. The cohort that received intra-articular antibiotics was compared with the cohort that did not to determine the effect of prophylactic intra-articular antibiotic administration in preventing infection. There was 1 deep infection in the antibiotic group compared with 5 in the non-antibiotic group (P<.001). Superficial infections developed in 2 cases of patients treated with antibiotics; there were no superficial infections in patients treated without antibiotics (P=.62). One previous study evaluated intra-articular injection of antibiotics for shoulder arthroplasty and found significantly lower rates of infection with the injection of intra-articular gentamicin. In this retrospective follow-up study, the injection of intra-articular gentamicin or gentamicin and cefazolin effectively decreased rates of postoperative infection. At mean follow-up of 399 days, intra-articular antibiotics at the time of surgery resulted in significantly fewer deep infections. Given the minimal risk of adverse events and minimal cost, this is a valid method of reducing infections in total shoulder arthroplasty. [Orthopedics. 202x;4x(x):xx–xx.]

• Publisher: SLACK Incorporated,Slack, Inc,SLACK INCORPORATED
• Subject: Aminoglycosides / Antibiotics / Arthroplasty / Cardiovascular disease / Care and treatment / Chronic obstructive pulmonary disease / Complications and side effects / Debridement / Diabetes / Diagnosis / Disease prevention / Health aspects / Infection / Infections / Iodine / Joint replacement surgery / Pathology / Patient outcomes / Patients / Revisions / Rotator cuff / Shoulder / Shoulder replacement arthroplasty / Skin / Surgeons / Variables