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 traumatic 4 diseases of glenohumeral joint. Periprosthetic infection represents an infrequent but dreaded 5 complication (2-4%). Application of intrawound vancomycin powder seems to reduce periprosthetic 6 infections but limited information is available on its efficiency in shoulder arthroplasty. Purpose of 7 this study was to evaluate if the Vancomycin powder embedded in a collagen sponge could decrease 8 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 the 11 intraoperative insertion of intrawound vancomycin powder. Incidence of periprosthetic infection was 12 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 cases 15 of infection were observed in the control group (3.2%) (p-value <0.001) without subacromial 16 vancomycin application. No wound complications requiring revision were observed as a result of 17 intrawound vancomycin application. 18 Discussion: Intrawound vancomycin powder significantly reduces the rate of periprosthetic shoulder 19 infections without any increase in local and systemic aseptic complications at a minimum follow-up 20 of 12 months. 21 Conclusion: Our results support the use of intrawound local vancomycin for prophylaxis of shoulder 22 periprosthetic infections. 23 24 Keywords: Shoulder, Periprosthetic infection, Vancomycin powder, Infection, Total shoulder 25 arthroplasty 26 Level of evidence: Level III; Retrospective Cohort Comparison; Treatment Study