This article is more than 5 years old. Information may no longer be current.
Lower postop infection rate seen with intra-articular gentamicin given during TSA
An intraoperative, intra-articular injection of gentamicin significantly reduced the rate of postoperative infection among patients who underwent total shoulder replacement, according to the findings of a recently presented study.
"Even with the low cost and safety of this intervention combined with the statistical significance of our findings, we conclude that intra-articular intraoperative gentamicin administration may represent a reasonable means of reducing acute postoperative deep infection in total shoulder arthroplasty," study researcher Farshad Adib, MD, a fellow in adult reconstruction at the University of Virginia in Charlottesville, said during his presentation.
Adib and colleagues conducted a retrospective review of prospectively collected data for all total shoulder arthroplasties conducted by the senior study author between 2002 and 2011.
“Since June 2007, at the end of the shoulder arthroplasty, a spinal needle was inserted into the joint lateral to the acromion and 16 mg of gentamicin was injected into the joint,” Adib said. Gentamicin was chosen because of its low cost and success reported by other researchers for decreasing infection rates in total hip and knee arthroplasty cases, he said.
The study consisted of 504 patients with 343 patients in the intravenous gentamicin group and 164 patients in the control group.
Adib and colleagues reviewed the cases for the presence of deep postoperative infection within 90 days of surgery.
"Diagnosis has typically been made using a combination of a history, physical examination, [erythrocyte sedimentation rate] ESR, [C-reactive protein] CRP [and] sometimes aspiration," Adib said.
|
|
There were no significant differences between the groups for age, gender and comorbidities. Hypertension was present in 52.8% of patients in the gentamicin group, and 12.3% of patients in the group had diabetes. Rates of these comorbidities in the control group were 63.8% and 13.4%, respectively.
The investigators discovered a postoperative infection rate of 0.3% in the gentamicin group vs. 4.4% in the control group. Two patients in the gentamicin group and three patients in the control group underwent revision surgery.
“For the time being, we have no clear answer at how local gentamicin works,” Adib said. “It needs further investigation to see where it lowers the number of bacteria at the surgical site, or has an effect on the formation of the biofilm or some other mechanism.”
He also cited the retrospective design and changes in surgical technique are possible limitations of the study.
“It was not feasible to determine the impact of these changes on the rate of infection,” Adib said. “Further prospective, randomized studies are required to show the benefits of this technique, and also we can use different medications like vancomycin.”
Reference:
Adib F. Paper #12-4267. Presented at: 13th EFORT Congress; May 23-25, 2012; Berlin.
Disclosure: Adib has no relevant financial disclosures.
Perspective
Back to Top
Infection following shoulder arthroplasty is often a devastating complication requiring multiple surgeries and lengthy periods of intravenous antibiotics to eradicate the infection. Therefore, strategies to prevent infection clearly offer tremendous advantages to patients undergoing shoulder arthroplasty.
This study introduces a concept of intra-articular injection of gentamycin and observed a deceased early infection rate compared to a control group. As with many studies, this study raises many additional questions such as, how does the gentamycin function in this type of application, how does intra-articular antibiotic injection compare to use of cement impregnated with antibiotics and which antibiotics are best?
Finally, reverse shoulder arthroplasty, and especially when performed in the revision setting, has greater potential for infection than standard shoulder arthroplasty. It would interesting to see the effects of intra-articular antibiotic injection in that setting.