Intraoperative Intra-articular Antibiotic Injection Reduces Infection in Shoulder Arthroplasty

Area of Science:

• Orthopedic Surgery
• Infectious Disease Prevention
• Surgical Site Infections

Background:

• Deep infection is a serious complication following shoulder arthroplasty.
• Current prevention strategies primarily rely on intravenous antibiotics.
• The efficacy of intra-articular antibiotic prophylaxis in shoulder surgery requires further investigation.

Purpose of the Study:

• To evaluate the effectiveness of intra-articular antibiotic injections in reducing deep infection rates after shoulder arthroplasty.
• To compare infection rates between patients receiving intra-articular antibiotics and those receiving only intravenous antibiotics.
• To assess the impact of prophylactic intra-articular antibiotic administration on both deep and superficial surgical site infections.

Main Methods:

• Retrospective cohort study comparing two groups of shoulder arthroplasty patients.
• Group A (n=164): Received intravenous antibiotics only (pre-2007).
• Group B (n=1324): Received intra-articular gentamicin, with cefazolin added from January 2014 (2007-2018).

Main Results:

• Significantly lower deep infection rates in the intra-articular antibiotic group (1 infection) compared to the non-antibiotic group (5 infections) (P<.001).
• No significant difference in superficial infection rates between the groups (2 vs. 0, P=.62).
• Intra-articular antibiotics demonstrated a marked reduction in postoperative deep infections at a mean follow-up of 399 days.

Conclusions:

• Intra-articular antibiotic administration, including gentamicin or gentamicin with cefazolin, is an effective method for decreasing deep postoperative infections in total shoulder arthroplasty.
• This prophylactic approach presents minimal risk of adverse events and is cost-effective.
• Intra-articular antibiotics represent a valuable strategy for enhancing patient safety and reducing complications in shoulder replacement surgery.