Vancomycin powder embedded in collagen sponge decreases the rate of prosthetic shoulder infection

Background: Shoulder arthroplasty is a successful procedure to treat the degenerative and traumatic4 diseases of glenohumeral joint. Periprosthetic infection represents an infrequent but dreaded5 complication (2-4%). Application of intrawound vancomycin powder seems to reduce periprosthetic6 infections but limited information is available on its efficiency in shoulder arthroplasty. Purpose of7 this study was to evaluate if the Vancomycin powder embedded in a collagen sponge could decrease8 the rate of prosthetic shoulder infection.9 Methods: A retrospective analysis of 827 patients undergoing Total Shoulder Arthroplasty (TSA)10 was performed. The study involved a control group of 405 patients and a group of 422 with the11 intraoperative insertion of intrawound vancomycin powder. Incidence of periprosthetic infection was12 evaluated comparing the two groups at a minimum follow-up of 12 months. Patient demographics,13 comorbidities and perioperative information were compared between the two groups.14 Results: No infection was observed in the group treated with intrawound vancomycin, and 13 cases15 of infection were observed in the control group (3.2%) (p-value <0.001) without subacromial16 vancomycin application. No wound complications requiring revision were observed as a result of17 intrawound vancomycin application.18 Discussion: Intrawound vancomycin powder significantly reduces the rate of periprosthetic shoulder19 infections without any increase in local and systemic aseptic complications at a minimum follow-up20 of 12 months.21 Conclusion: Our results support the use of intrawound local vancomycin for prophylaxis of shoulder22 periprosthetic infections.2324 Keywords: Shoulder, Periprosthetic infection, Vancomycin powder, Infection, Total shoulder25 arthroplasty26 Level of evidence: Level III; Retrospective Cohort Comparison; Treatment Study