Meeting News

First-time TSA, rotator cuff repair had similar rates of positive cultures

NEW ORLEANS — Patients undergoing either total shoulder arthroplasty or rotator cuff repair for the first time had similar rates of developing positive cultures, of which Propionibacterium acnes were most of the cultures, according to results presented at the American Shoulder and Elbow Surgeons Annual Meeting.

Eric R. Ricchetti

Eric T. Ricchetti, MD, and colleagues obtained five intraoperative culture specimens, a synovial fluid sample and four tissue samples among 50 patients with glenohumeral osteoarthritis undergoing primary total shoulder arthroplasty and 50 patients without arthritis undergoing primary arthroscopic rotator cuff repair. Researchers sent all specimens for 14-day anaerobic culture hold for detection of P. acnes, and part of the synovial fluid sample was sent separately for measurement of 11 different cytokine levels. Researchers compared synovial cytokine levels between patients with and those without positive culture results, as well as across procedure type.

Ricchetti noted a 42% positive culture rate across cases with at least one positive culture, the majority of which were P. acnes.

“However, only 18% of these cases had growth of multiple cultures of the same organism,” Ricchetti said. “These were all P. acnes cases.”

Results showed no difference in the positive culture rate between procedures, and no association between a history of prior cortisone injection and higher positive culture rate. According to Ricchetti, none of the patients who had positive cultures had any clinical evidence of infection postoperatively.

“We did find that males showed a significantly higher positive culture rate than females for P. acnes and this went, again, across all cases for when you looked at these specific procedures,” he said.

Regardless of culture results, patients with arthritis had a significantly higher prevalence of multiple cytokines vs. patients without arthritis, Ricchetti noted.

“However, synovial cytokine levels were not significantly different when comparing cases with and without positive culture results, regardless of the procedure,” he said. – by Casey Tingle

 

Reference:

Ricchetti ET, et al. Paper #19. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 12-14, 2017; New Orleans.

 

Disclosure: Ricchetti reports he is a board or committee member of the American Association of Orthopaedic Surgeons and of the American Shoulder and Elbow Surgeons; receives research support from DePuy; is a paid consultant for DJ Orthopaedics; and receives publishing royalties, financial or material support from the Journal of Bone and Joint Surgery – American.

NEW ORLEANS — Patients undergoing either total shoulder arthroplasty or rotator cuff repair for the first time had similar rates of developing positive cultures, of which Propionibacterium acnes were most of the cultures, according to results presented at the American Shoulder and Elbow Surgeons Annual Meeting.

Eric R. Ricchetti

Eric T. Ricchetti, MD, and colleagues obtained five intraoperative culture specimens, a synovial fluid sample and four tissue samples among 50 patients with glenohumeral osteoarthritis undergoing primary total shoulder arthroplasty and 50 patients without arthritis undergoing primary arthroscopic rotator cuff repair. Researchers sent all specimens for 14-day anaerobic culture hold for detection of P. acnes, and part of the synovial fluid sample was sent separately for measurement of 11 different cytokine levels. Researchers compared synovial cytokine levels between patients with and those without positive culture results, as well as across procedure type.

Ricchetti noted a 42% positive culture rate across cases with at least one positive culture, the majority of which were P. acnes.

“However, only 18% of these cases had growth of multiple cultures of the same organism,” Ricchetti said. “These were all P. acnes cases.”

Results showed no difference in the positive culture rate between procedures, and no association between a history of prior cortisone injection and higher positive culture rate. According to Ricchetti, none of the patients who had positive cultures had any clinical evidence of infection postoperatively.

“We did find that males showed a significantly higher positive culture rate than females for P. acnes and this went, again, across all cases for when you looked at these specific procedures,” he said.

Regardless of culture results, patients with arthritis had a significantly higher prevalence of multiple cytokines vs. patients without arthritis, Ricchetti noted.

“However, synovial cytokine levels were not significantly different when comparing cases with and without positive culture results, regardless of the procedure,” he said. – by Casey Tingle

 

Reference:

Ricchetti ET, et al. Paper #19. Presented at: American Shoulder and Elbow Surgeons Annual Meeting; Oct. 12-14, 2017; New Orleans.

 

Disclosure: Ricchetti reports he is a board or committee member of the American Association of Orthopaedic Surgeons and of the American Shoulder and Elbow Surgeons; receives research support from DePuy; is a paid consultant for DJ Orthopaedics; and receives publishing royalties, financial or material support from the Journal of Bone and Joint Surgery – American.

    Perspective

    This is important work by Ricchetti and colleges. P. acnes continues to be a problem not only in total joint replacement of the shoulder, but all shoulder surgery. The information supports other researchers’ findings that P. acnes is found in most shoulder procedures in which the shoulder being operated one was not previously operated on. This has been found in arthroscopic procedures, as well as surgery that requires an incision. This organism has been shown by researchers from the University of Washington to be living in and on the skin of patients. It appears to be more prevalent in male patients than female patients most likely due to the increased hair follicles and sebaceous glands that men have. Most of the infections caused by this organism occur in revision surgeries that may have been contaminated from the previous surgical procedure on the shoulder. This study confirms there is a high rate of contamination with any surgery in the shoulder that then will cause any subsequent procedure to trigger the clinical relevant infection. This study confirms the importance of trying to decontaminate the skin and subcutaneous layers at the time of any shoulder surgical procedure. This may be possible with specific skin preparation or antibiotics that are effective or specific to P. acnes.

    References:

    Lee MJ, et al. J Bone Joint Surg Am. 2014;doi:10.2106/JBJS.M.01474.

    Patel A, et al. J Shoulder Elbow Surg. 2009;doi:10.1016/j.jse.2009.01.023.

    • Lynn A. Crosby, MD
    • Professor and director of shoulder surgery Medical College of Georgia Augusta University Augusta, Georgia

    Disclosures: Crosby reports he is a consultant and receives royalties from Exactech for design of reverse shoulder arthroplasty.

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