Survey of shoulder arthroplasty surgeons' methods for infection avoidance of Propionibacterium.
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ABSTRACT: Introduction
Propionibacterium acnes infection after shoulder arthroplasty remains a source of morbidity. Determining practices amongst shoulder surgeons is the first step in developing infection-prevention best-practices.Methods
A survey was sent to a shoulder fellowship alumni group to determine their arthroplasty infection prevention methods.Results
74% completed the survey. Cefazolin (90%), vancomycin (50%) and clindamycin (18%) were the most commonly used antibiotics, 61% utilized more than one antibiotic. Most (76%) reported using an experience-based protocol learned during residency/fellowship.Discussion and conclusion
There are no clear standards for prevention of Propionibacterium acnes infections in shoulder arthroplasty. There is a general non-scientific approach to the prevention of shoulder arthroplasty infection.
SUBMITTER: Parada SA
PROVIDER: S-EPMC5895935 | biostudies-literature | 2018 Mar
REPOSITORIES: biostudies-literature
Publications
Survey of shoulder arthroplasty surgeons' methods for infection avoidance of <i>Propionibacterium</i>.
Parada Stephen A SA Shaw K Aaron KA Eichinger Josef K JK Stadecker Monica J MJ Higgins Laurence D LD Warner Jon J P JJP
Journal of orthopaedics 20180202 1
<h4>Introduction</h4><i>Propionibacterium acnes</i> infection after shoulder arthroplasty remains a source of morbidity. Determining practices amongst shoulder surgeons is the first step in developing infection-prevention best-practices.<h4>Methods</h4>A survey was sent to a shoulder fellowship alumni group to determine their arthroplasty infection prevention methods.<h4>Results</h4>74% completed the survey. Cefazolin (90%), vancomycin (50%) and clindamycin (18%) were the most commonly used anti ...[more]
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Project description:BackgroundPropionibacterium species are commonly cultured from specimens harvested at the time of revision shoulder arthroplasty. These bacteria reside in normal sebaceous glands, out of reach of surgical skin preparation. The arthroplasty incision transects these structures, which allows Propionibacterium to inoculate the wound and to potentially lead to the formation of a biofilm on the inserted implant. To help identify patients who are at increased risk for wound inoculation, we investigated whether preoperative cultures of the specimens from the unprepared skin surface were predictive of the results of intraoperative cultures of dermal wound-edge specimens obtained immediately after incision of the surgically prepared skin.MethodsSixty-six patients (mean age, 66.1 ± 9.4 years [range, 37 to 82 years]; 73% male) undergoing primary shoulder arthroplasty had preoperative cultures of the unprepared skin surface and intraoperative cultures of the freshly incised dermis using special culture swabs. For the first 50 patients, a control swab was opened to air during the same time that the dermal specimen was obtained. The results for female and male patients were characterized as the Specimen Propionibacterium Value (SpPV). We then determined the degree to which the results of cultures of the skin surface specimens were predictive of the results of culture of the dermal specimens.ResultsThe skin-surface SpPV was ≥1 in 3 (17%) of the 18 female patients and 34 (71%) of the 48 male patients (p < 0.001). The dermal SpPV was ≥1 in 0 (0%) of the 18 female patients and 19 (40%) of the 48 male patients (p < 0.001). None of the control samples had an SpPV of ≥1. The predictive characteristics of a skin-surface SpPV of ≥1 for a dermal SpPV of ≥1 were as follows: sensitivity, 1.00 (95% confidence interval [CI], 0.82 to 1.00); specificity, 0.62 (95% CI, 0.46 to 0.75); positive predictive value, 0.51 (95% CI, 0.34 to 0.68); and negative predictive value, 1.00 (95% CI, 0.88 to 1.00).ConclusionsA preoperative culture of the unprepared skin surface can help to predict whether the freshly incised dermal edge is likely to be positive for Propionibacterium. This test may help to identify patients who may merit more aggressive topical and systemic antibiotic prophylaxis.Clinical relevanceThis study shows that surgeons have the opportunity to use preoperative skin cultures to determine the likelihood that the shoulder arthroplasty wound will be culture-positive for Propionibacterium.
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Project description:BackgroundBilateral total hip arthroplasty may be performed simultaneously (SIMTHA) or in two staged operations.AimTo assess attitudes towards and utilization of SIMTHA in Irish orthopaedic practice, and to assess patient and surgeon factors which are associated with the management of bilateral hip arthritis.MethodsA 16-question electronic survey (Google Forms) was distributed via email to consultant Irish orthopaedic surgeons who perform total hip arthroplasty, followed by a reminder 1 month later. A p value < 0.05 was considered significant.ResultsThere were 53 responses from arthroplasty surgeons, with 28% reporting they never perform SIMTHA, 26% have performed ≤ 5 SIMTHA, and 46% do ≥ 1 SIMTHA per year. Amongst the 15 surgeons who do not do SIMTHA, 60% reported a preference for staged arthroplasty, 20% felt it was not feasible in their institution, and a third reported a lack of experience with SIMTHA. There was a significant association between not performing SIMTHA and years of consultant experience (p = 0.002). There were no institutional guidelines on eligibility criteria for SIMTHA. The most common time interval for staged bilateral arthroplasty was 6-12 weeks (60%). Overall, 56% of surgeons felt SIMTHA is underutilised in the Irish healthcare system; this was associated with greater SIMTHA volume (p = 0.023).ConclusionHalf of the Irish arthroplasty surgeons report SIMTHA is a regular aspect of their practice. Performing SIMTHA is associated with greater arthroplasty volume, more recent consultant appointments, and a perception that the operation is underutilised.
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Project description:BackgroundWe assessed the contribution of reverse shoulder arthroplasty to overall utilization of primary shoulder arthroplasty and present age- and sex-stratified national rates of shoulder arthroplasty. We also assessed contemporary complication rates, mortality rates, and indications for shoulder arthroplasty, as well as estimates and indications for revision arthroplasty.MethodsWe used the Nationwide Inpatient Samples for 2009 through 2011 to calculate estimates of shoulder arthroplasty and assessed trends using Joinpoint (National Cancer Institute, Bethesda, MD) regression.ResultsThe cumulative estimated utilization of primary shoulder arthroplasty (anatomic total shoulder arthroplasty, hemiarthroplasty, and reverse shoulder arthroplasty) increased significantly from 52,397 procedures (95% confidence interval [CI], 47,093-57,701) in 2009 to 67,184 cases (95% CI, 60,638-73,731) in 2011. Reverse shoulder arthroplasty accounted for 42% of all primary shoulder arthroplasty procedures in 2011. The concomitant diagnosis of osteoarthritis and rotator cuff impairment was found in only 29.8% of reverse shoulder arthroplasty cases. The highest rate of reverse shoulder arthroplasty was in the 75- to 84-year-old female subgroup (77 per 100,000 persons; 95% CI, 67-87). Revision cases comprised 8.8% and 8.2% of all shoulder arthroplasties in 2009 and 2011, respectively, and 35% of revision cases were because of mechanical complications/loosening whereas 18% were because of dislocation.ConclusionsThe utilization of primary shoulder arthroplasty significantly increased in just a 3-year time span, with a major contribution from reverse shoulder arthroplasty in 2011. Indications appear to have expanded because a large percentage of patients did not have rotator cuff pathology. The burden from revision arthroplasties was also substantial, and efforts to optimize outcomes and longevity of primary shoulder arthroplasty are needed.
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