Vancomycin Soaking to Reduce Intraoperative Contamination by During the Latarjet Procedure.

BACKGROUND

Postoperative infection after the Latarjet procedure, ranging from 1% to 6%, can compromise the functional outcome of young athletes. is a main pathogen as a consequence of an intraoperative contamination.

PURPOSE

To evaluate intraoperative contamination with and the effectiveness of the local application of vancomycin during the Latarjet procedure.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

This was a single-center study including 75 patients (mean age, 26 years; range, 15-55 years) operated on for anterior shoulder instability with the primary open Latarjet procedure; they underwent the same protocol of skin preparation and preoperative prophylactic antibiotics. Three groups of 25 patients were created and divided sequentially, without the results of each group being known before the end of the study: group A (5 mg/mL of vancomycin), group B (20 mg/mL of vancomycin), and group C (control group with no vancomycin). Swab samples of the coracoid were taken before sectioning the coracoid process (time 1) and after its preparation (time 2). The coracoid was then wrapped in gauze impregnated with different concentrations of vancomycin, except for group C. A final sample (time 3) was taken before screwing the bone block onto the glenoid. All samples were cultured for 21 days, and patients underwent clinical and radiological follow-up for 6 months.

RESULTS

The contamination rates at times 1, 2, and 3 were 25%, 44%, and 45%, respectively, without significant difference. There was no significant difference between groups A and B with respect to the number of positive cultures at each time point. Of 9 positive cultures at time 1, all were still positive at time 3 in group A, whereas 3 of 5 were negative in group B ( = .027). The rate of at time 3 in the control group was higher than that in the 2 other groups (68% vs 44% for group A and 20% for group B; = .003). Body mass index was the only prognostic factor for a -positive culture (26.05 ± 3.39 vs 23.34 ± 2.33; = .018). No clinical infection was reported at the 6-month postoperative follow-up.

CONCLUSION

The rate of contamination ranged from 25% to 68% during the open Latarjet procedure in young athletes. Vancomycin reduced the bacterial contamination when it was used at high concentrations in a gauze wrap on the coracoid. The type of detected and its clinical implications remain to be studied.