Use of Vancomycin Powder in Shoulder Arthroplasty: Preliminary Results
DOI:
https://doi.org/10.82189/spot.47Keywords:
Antibiotic Prophylaxis, Arthroplasty, Replacement, Shoulder, Postoperative Complications/prevention & control, Powders, Prosthesis‑Related Infections/prevention & control, Shoulder Joint, Vancomycin/therapeutic useAbstract
Introduction: The use of intraoperative vancomycin powder as prophylaxis in spine surgery, as well as in knee and hip surgery, has been well established in the literature, but evidence is lacking regarding the role of its use in shoulder arthroplasty. This study aims to compare the infection rates between patients undergoing shoulder arthroplasty with intraoperative use of vancomycin powder and those managed with the standard protocol without local antibiotic application.
Methods: We designed a retrospective controlled study, including all patients submitted to shoulder arthroplasty in our Orthopedics Department between 2018 and 2020. We divided them into two groups: the intervention group, which received the powder, and a control group. The intervention technique consisted of using 1 g of vancomycin powder directly between all bone and metal interfaces and between all implant interfaces during surgery, and deeply into the muscular planes, before wound closure. Data contained in clinical files were collected, summarily, use of vancomycin powder, need for revision, and suspected infection, according to clinical and analytical criteria (EBJIS).
Results: Ninety-five patients were included, divided into an intervention group of 39 patients and a control group of 56 patients. Mean surgery duration in the study group was 103±30103±30 minutes, and in the control group was 145±40145±40 minutes [p>0.05][p>0.05]. The rate of infection was 2.11%2.11%, occurring in the control group, concerning trauma cases. No infections were found in the vancomycin group. An association between infection and the absence of prophylactic vancomycin powder use was not statistically significant [p=0.514][p=0.514].
Conclusion: The use of local vancomycin powder might be a reasonable option for infection prevention in shoulder arthroplasty.
Downloads
References
Fink B, Sevelda F. Periprosthetic Joint Infection of Shoulder Arthroplasties: Diagnostic and Treatment Options. BioMed Res Int. 2017;2017:4582756. doi: 10.1155/2017/4582756.
Coste JS, Reig S, Trojani C, Berg M, Walch G, Boileau P. The management of infection in arthroplasty of the shoulder. J Bone Joint Surg Br. 2004;86:65-9.
Saltzman MD, Marecek GS, Edwards SL, Kalainov DM. Infection after shoulder surgery. J Am Acad Orthop Surg. 2011;19:208-18. doi: 10.5 435/00124635-201104000-00005.
Bohsali KI, Bois AJ, Wirth MA. Complications of Shoulder Arthroplasty. J Bone Joint Surg Am. 2017;99:256-69. doi: 10.2106/jbjs.16.00935.
McNally M, Sousa R, Wouthuyzen-Bakker M, Chen AF, Soriano A, Vogely HC, et al. The EBJS definition of periprosthetic joint infection. Bone Joint J. 2021;103-b:18-25. doi: 10.1302/0301-620x.103b1. Bji-2020-1381. R1.
Parada SA, Shaw KA, Eichinger JK, Stadecker MJ, Higgins LD, Warner JJ. Survey of shoulder arthroplasty surgeons' methods for infection avoidance of Propionibacterium. J Orthop. 2018;15:177-180. doi: 10.1016/j.jor.2018.01.052.
Clark JJ, Abildgaard JT, Backes J, Hawkins RJ. Preventing infection in shoulder surgery. J Shoulder Elbow Surg. 2018;27:1333-41. doi: 10.1016/j.jse.2017.12.028.
O'Neill KR, Smith JG, Abtahi AM, Archer KR, Spengler DM, McGirt MJ, et al. Reduced surgical site infections in patients undergoing posterior spinal stabilization of traumatic injuries using vancomycin powder. Spine J. 2011;11:641-6. doi: 10.1016/j.spinee.2011.04.025.
Patel NN, Guild GN, 3rd, Kumar AR. Intravenous vancomycin in primary hip and knee arthroplasty: a safe and cost-effective means to decrease early periprosthetic joint infection. Arthroplast Today. 2018;4:479-83. doi: 10.1016/j.artd.2018.07.011.
Sweet FA, Roh M, Silva C. Intravenous application of vancomycin for prophylaxis in instrumented thoracolumbar fusions: efficacy, drug levels, and patient outcomes. Spine. 2011;36:2084-8. doi: 10.1097/ BRS.0b013e3181ff2cb.
Weber P, Utzschneider S, Sadoghi P, Andress HJ, Jansson V, Müller PE. Management of the infected shoulder prosthesis: a retrospective analysis and review of the literature. Int Orthop. 2011;35:365-373. doi: 10.1007/s00264-010-1019-3.
Richards J, Inacio MC, Beckett M, Navarro RA, Singh A, Dillon MT, et al. Patient and procedure-specific risk factors for deep infection after primary shoulder arthroplasty. Clin Orthop Relat Res. 2014;472:2809-15. doi: 10.1007/s11999-014-3696-5.
Seok HG, Park JJ, Park SG. Risk factors for periprosthetic joint infection after shoulder arthroplasty: systematic review and meta-analysis. J Clin Med. 2022;11. doi: 10.3390/jcm11144245.
Bakhsheshian J, Dahdaleh NS, Lam SK, Savage JW, Smith ZA. The use of vancomycin powder in modern spine surgery: systematic review and meta-analysis of the clinical evidence. World Neurosurg. 2015;83:816-23. doi: 10.1016/j.wneu.2014.12.033.
Brazilian Society of Neurosurgery - Spine Department; Joaquim AF, Milano JB, Daniel JW, Dantas FL, Onishi FJ, et al. Spine surgery - the use of vancomycin powder in surgical site for postoperative infection prevention. Rev Assoc Med Bras. 2018;64:663-9. doi: 10.1590/1806-9282.64.08.663.
Yan H, He J, Chen S, Yu S, Fan C. Intravenous application of vancomycin reduces wound infection after open release of post-traumatic stiff elbows: a retrospective comparative study. J Shoulder Elbow Surg. 2014;23:686-92. doi: 10.1016/j.jse.2014.01.049.
Miquel J, Huang TB, Athwal GS, Faber KJ, O'Gorman DB. Vancomycin is effective in preventing Cutibacterium acnes growth in a mimetic shoulder arthroplasty. J Shoulder Elbow Surg. 2022;31:159-64. doi: 10.1016/j.jse.2021.06.015.
Hosack LW, Overstreet DJ, Lederman ES. In vitro susceptibility of Propionibacterium acnes to simulated intravenous vancomycin concentrations. JSES Open Access. 2017;1:125. doi: 10.1016/j.jses.2017.08.001.
Horneff JG, Hsu JE, Huffman GR. Propionibacterium acnes infections in shoulder surgery. Orthop Clin North Am. 2014;45:515-21. doi: 10.1016/j.jocd.2014.06.004.
Qiu B, Al K, Pena-Diaz AM, Drosdowech D, Faber KJ, Burton JP, et al. Cutibacterium acnes and the shoulder microbiome. J Shoulder Elbow Surg. 2018;27:1734-9. doi: 10.1016/j.jse.2018.04.019.
Smith ML, Gotmaker R, Hoy GA, Ek ET, Carr A, Flynn JN, et al. Minimizing Propionibacterium acnes contamination in shoulder arthroplasty: use of a wound protector. ANZ J Surg. 2018;88:1178-81. doi: 10.1111/j.ans.14821.
Eaniew N, Khan M, Drew B, Peterson D, Bhandari M, Ghert M. Intravenous vancomycin to prevent infections after spine surgery: a systematic review and meta-analysis. Eur Spine J. 2015;24:533-42. doi: 10.1007/s00586-014-3357-0.
Murphy EP, Curtin M, Shafqat A, Byrne F, Jadaan M, Rahall E. A review of the application of vancomycin powder to posterior spinal fusion wounds with a focus on side effects and infection. A prospective study. Eur J Orthop Surg Traumatol. 2017;27:187-91. doi: 10.1007/s00590-016-1878-4.
Hatch MD, Daniels SD, Glerum KM, Higgins LD. The cost effectiveness of vancomycin for preventing infections after shoulder arthroplasty: a break-even analysis. J Shoulder Elbow Surg. 2017;26:472-7. doi: 10.1016/j.jse.2016.07.071.
Gadir R, Ochsner JL, Chimento GF, Meyer MS, Waddell B, Zavatsky JM. Establishing a role for vancomycin powder application for prosthetic joint infection prevention-results of a wear simulation study. J Arthroplasty. 2014;29:1449-56. doi: 10.1016/j.arth.2014.02.012.
Downloads
Published
Data Availability Statement
Os dados clínicos poderão ser disponibilizados de acordo com solicitação.
Issue
Section
License
Copyright (c) 2026 Joana Maria Tavares Almeida, Maria J. Leite, Bernardo Nunes, Manuel R. Silva, Manuel Gutierres, João Torres
This work is licensed under a Creative Commons Attribution 4.0 International License.
