These authors sought to determine the rate and characteristics of positive intraoperative cultures in a cohort of patients undergoing primary shoulder arthroplasty without prior surgery.
The average age at surgery was 70.5 years (range, 50-91 years), and 41 patients (47%) were male.
All patients received standard preoperative antibiotic prophylaxis, usually cefazolin. All surgeons routinely used space suit surgical attire for the procedure. All surgeons used a similar chlorhexidine-based skin preparation and draping protocol that included iodophor-impregnated surgical drapes.
All patients received standard preoperative antibiotic prophylaxis, usually cefazolin. All surgeons routinely used space suit surgical attire for the procedure. All surgeons used a similar chlorhexidine-based skin preparation and draping protocol that included iodophor-impregnated surgical drapes.
3 to 4 cultures specimens included (1) an attempted synovial fluid aspiration through the subscapularis tendon, and tissue culture of(2) the rotator interval, (3) intra-articular biceps tendon tissue, and (4) anterior capsular tissue. Individual specimens were collected with fresh instruments, placed into specimen containers, and sealed. Specimens were sent to an independent laboratory for aerobic, anaerobic, and fungal culture and were held for 13 days before being finalized.
At least 1 positive culture was found in 33 shoulders (38%), with 17 patients (19%) having ≥2 positive cultures. Cutibacterium (formerly Propionibacterium) acnes was the most common organism (67%), followed by coagulase-negative Staphylococcus (21%), Staphylococcus aureus (3%), and other organisms (18%).
The rate of positive culture was higher in men (51%) than in women (26%, P = .016). Cutibacterium acnes was more common in men with positive cultures (95% vs. 17%, P < .001) and coagulase-negative Staphylococcus and Staphylococcus epidermidis were more common in women with positive cultures (42% vs. 10%, P = .071).
Post surgical followup duration ranged from 0.1 to 2 years; no patient was diagnosed as having an infection in this period.
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This study again confirms that space suits, preoperative antibiotics, chlorhexidine-based skin preparation, and iodophor-impregnated surgical drapes do not prevent the presence of bacteria in shoulder arthroplasty wounds.
The most likely source of the bacteria recovered in this study is the bacteria on or in the skin of the patient at the time the incision is made.
It is of interest that the youngest patient in this study was 50 years of age. Younger male patients are thought to have higher loads of Propionibacterium in their sebaceous glands. Thus the rate of positive cultures for this organism may have been even higher had younger male patients been included.
One can only conclude that shoulder arthroplasty wounds are not sterile. Bacteria introduced at the time of surgery may colonize the implants and come to reside in biofilms on their surface. These colonized biofilms may result in pain, stiffness and/or component loosening presenting months or years after the index procedure.
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Use the "Search" box to the right to find other topics of interest to you.
You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'
