Intraoperative intra-articular injection of gentamicin: will it decrease the risk of infection in total shoulder...

Area of Science:

• Orthopedic Surgery
• Infectious Disease Prevention
• Pharmacology

Background:

• Deep infection is a serious complication following shoulder arthroplasty.
• Intra-articular antibiotic delivery achieves higher local concentrations than intravenous administration.
• This study investigated the efficacy of intraoperative gentamicin injection in reducing infection rates.

Purpose of the Study:

• To evaluate the impact of intra-articular gentamicin on deep infection rates after shoulder arthroplasty.
• To compare infection rates in patients receiving and not receiving intraoperative intra-articular gentamicin.
• To assess the safety and effectiveness of local antibiotic prophylaxis.

Main Methods:

• Retrospective review of 507 shoulder arthroplasties performed between 2005 and 2011.
• Comparison of infection rates between patients who received (group B, n=343) and did not receive (group A, n=164) intra-articular gentamicin.
• All patients received systemic prophylactic antibiotics; group B received an additional 160 mg of gentamicin intra-articularly.
• Minimum 1-year follow-up for all patients.

Main Results:

• The infection rate in group A (no intra-articular gentamicin) was 3.0% (5/164).
• The infection rate in group B (with intra-articular gentamicin) was 0.29% (1/343).
• Demographic and comorbidity profiles were similar between the groups, indicating gentamicin as the likely differentiating factor.

Conclusions:

• Intra-articular intraoperative gentamicin administration is associated with a significant reduction in deep postoperative infection rates after shoulder arthroplasty.
• Local antibiotic prophylaxis with gentamicin represents a potentially effective strategy to enhance surgical site infection prevention.
• Further prospective studies may be warranted to confirm these findings.