title: Antibiotic-loaded bone cement reduces deep infection rates for primary reverse total shoulder arthroplasty: a retrospective, cohort study of 501 shoulders.
abstract: BACKGROUND
  Deep infection after primary reverse total shoulder arthroplasty is a devastating event and has an increased incidence compared with anatomic total shoulder arthroplasty. Recent reports in the hip and knee arthroplasty literature suggest that antibiotic-loaded bone cement may lower infection rates for primary arthroplasties. We conducted a retrospective cohort study to evaluate the effect of antibiotic-loaded bone cement vs plain bone cement on the prevention of deep infection after primary reverse total shoulder arthroplasty.
  
  
  METHODS
  Four surgeons from their respective facilities participated in the retrospective cohort data collection. From 1999 to 2008, 501 consecutive primary reverse total shoulder arthroplasties were performed. Patients with revision of failed previous arthroplasties were excluded, and patients with any other previous shoulder procedure were included. Two groups were examined in this retrospective cohort: In group 1 (265 shoulders), the cement used for humeral fixation did not have antibiotics; in group 2 (236 shoulders), antibiotic-impregnated bone cement containing tobramycin, gentamycin, or vancomycin/tobramycin was used for fixation.
  
  
  RESULTS
  At an average postoperative follow-up of 37 months, no deep infection had developed in the 236 shoulders in group 2, whereas a deep infection had developed in 8 of the 265 shoulders (3.0%) in group 1. This difference between the groups was significant (P < .001).
  
  
  CONCLUSIONS
  Antibiotic-impregnated bone cement was effective in the prevention of postoperative deep infection after primary reverse total shoulder arthroplasty during short-term follow-up.
authors.affiliation: Orthopaedic and Neurological Consultants, Inc., New Albany, OH 43054, USA. nowinski@pol.net
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Nowinski
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gillespie
authors.forename: Yousef
authors.initials: Y
authors.lastname: Shishani
authors.forename: Brian
authors.initials: B
authors.lastname: Cohen
authors.forename: Gilles
authors.initials: G
authors.lastname: Walch
authors.forename: Reuben
authors.initials: R
authors.lastname: Gobezie
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D019072:Antibiotic Prophylaxis / Q000379:methods*; D019643:Arthroplasty, Replacement / Q000009:adverse effects* / Q000379:methods; D001843:Bone Cements / Q000627:therapeutic use*; D015331:Cohort Studies; D016503:Drug Delivery Systems; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000517:prevention & control*; D012016:Reference Values; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D001843:Bone Cements