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0 reviewsCutibacterium acnes (C acnes) is commonly responsible for periprosthetic joint infections after total shoulder arthroplasty (TSA). Chlorhexidine gluconate (CHG) has been shown to decrease the prevalence of C acnes when used in preoperative skin preparations. However, the bacterium is found within the dermal layer of the skin and unable to be completely eradicated with preoperative skin preparations. This study aims to determine if the use of 0.05% CHG lavage of the subcutaneous tissues decreases the incidence of positive superficial and deep C acnes cultures in primary TSA.
Methods
This was a prospective, 2-arm, single-surgeon, single-blinded, randomized controlled trial. All patients scheduled for a primary anatomic or reverse TSA were screened for enrollment at a single institution. Patients were randomized to a saline irrigation or a 0.05% CHG irrigation of the exposed dermal and subcutaneous layer after incision. Five culture samples were taken during surgery. The first was taken from the skin prior to incision and followed by a baseline superficial subcutaneous culture before lavage. Following lavage, 1 additional superficial culture and 2 deep cultures were taken prior to bony preparation. All cultures were incubated and examined for C acnes growth for 21 days. The study was adequately powered at 85% with a type I error rate of 0.05. An ordinal regression analysis for each culture swab site was performed to determine odds ratios (ORs), with the irrigation group (saline/CHG) serving as the independent variable.
Results
One hundred twenty six patients were enrolled into 2 groups: normal saline (n = 63) and CHG (n = 63). The 2 groups did not have any significant differences in baseline demographic characteristics. The study group that underwent normal saline irrigation had more than double the risk of C acnes contamination at the deep surgical level compared with the group that had 0.05% CHG as the surgical irrigation solution