The Effect of Pretreatment for Propionibacterium Acnes on Surgical Site Burden in Shoulder Arthroplasty
NCT ID: NCT04112407
Last Updated: 2023-08-30
Study Results
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Basic Information
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COMPLETED
NA
120 participants
INTERVENTIONAL
2019-01-10
2022-12-31
Brief Summary
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Detailed Description
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1. Control: standard preparation of the surgical site without P. acnes pretreatment
2. BPO group: Pretreatment with 2 days of washes prior to surgery
3. BPO and Phototherapy: 2 days of washes with 3 treatments of blue spectrum phototherapy
Patients will be seen at our office will be consented and recruited into the study. Subjects will have standard of care evaluation including: radiographs, preoperative labs and clearances. If selected and agreeable, treatment with phototherapy will involve the application of three sessions lasting 3 minutes preoperatively; the sessions will be conducted by the patient at home for two days prior to surgery and in the preoperative holding area. During each application, protective eyewear will be used. For patients in the BPO groups, a 10% benzoyl peroxide wash will be used globally on the operative shoulder and axilla during showering. An educational leaflet will outline the surgical field in addition to temporary demarcation at the time of BPO pickup at the office. Additional tests, imaging or procedures will be at the discretion of the treating physician and documented during the study. During the postoperative visit at 10-14 days, the post operative wound will be assessed in the standard manner. Final culture results will be recorded for each patient and documented in the study database.
* The surgical site will be prepared in usual fashion with Chloroprep and the patients will receive preoperative Cefazolin (or vancomycin based on penicillin allergy)
* Following both draping and skin incision, the surgeons gloves will be changed; any blades used in the skin incision will also be discarded
* Intraoperative cultures will be taken following established protocols, published in the literature: an excisional biopsy 1cm long and 3mm wide will be taken from the medial wound edge at the time of incision; the superficial dermal tissue will be swabbed immediately after the biopsy is taken and finally, a swab of the glenohumeral (shoulder) joint will be performed prior to closure at the end of the procedure and after insertion of the implant.
* Specimens will be transported to the laboratory adjoining the operating room at our institution within 1 hour of harvesting and processed by microbiology technicians in a laminar flow biological safety hood. Tissue from the skin edge will be homogenized in sterile saline solution and plated on media: blood agar, chocolate agar, Brucella agar, MacConkey agar, Columbia nalidixic acid agar and phenylethyl alcohol anaerobic blood agar. All media will be incubated at 37C for 14 days.
* Specimens will be incubated for 14 days in aerobic and anaerobic media to detect P acnes and other organisms
* Culture results will not be discussed with patients; patients will be consented to not know their results as they are not clinically significant
* Prophylactic antibiotic treatment of positive cultures will not be performed in any case.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
PREVENTION
NONE
Study Groups
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Control
Standard preparation of the surgical site without P. acnes pretreatment
Control
Standard surgical site preparation with no P. acnes pretreatment
BPO Group
Pretreatment with 10% Benzoyl peroxide body wash for two consecutive days of washes prior to surgery at home. The anterior shoulder area is wet before treatment; the wash is massaged in for 20 seconds producing a lather and washed off, patting dry.
Benzyl Peroxide
Benzyl peroxide wash to be used preoperatively during showering to the operative shoulder site.
BPO and Phototherapy
2 days of benzoyl peroxide washes and 3 treatments of blue light phototherapy. Pretreatment with 10% Benzoyl peroxide body wash for two consecutive days of washes prior to surgery at home. The anterior shoulder area is wet before treatment; the wash is massaged in for 20 seconds producing a lather and washed off, patting dry. The blue light phototherapy is administered to the shoulder for 3 minutes on three occasions; 2 days before, the day before surgery and in the preoperative area by the patient.
Blue Light Phototherapy
Phototherapy in the blue light spectrum
Benzyl Peroxide
Benzyl peroxide wash to be used preoperatively during showering to the operative shoulder site.
Interventions
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Blue Light Phototherapy
Phototherapy in the blue light spectrum
Benzyl Peroxide
Benzyl peroxide wash to be used preoperatively during showering to the operative shoulder site.
Control
Standard surgical site preparation with no P. acnes pretreatment
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* English fluency and literacy
* Able to provide informed consent
* Older than 18 years of age
* Surgical indications including: primary arthritis, rotator cuff arthropathy, post-traumatic arthritis
* Primary total shoulder, hemiarthroplasty, primary reverse total shoulder or shoulder resurfacing
Exclusion Criteria
* Recent steroid injection to the shoulder in the past 6 months
* Previous open or arthroscopic procedure of the shoulder joint
* Recent antibiotic use (within 90 days)
* Prisoners
18 Years
ALL
No
Sponsors
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Hospital for Special Surgery, New York
OTHER
Albany Medical College
OTHER
Responsible Party
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Joseph Zimmerman, MD
Attending Orthopaedic Surgeon, Department of Surgery, Division of Orthopaedic Surgery,
Principal Investigators
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Ian D Hutchinson, MD
Role: STUDY_DIRECTOR
Albany Medical College
Locations
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Albany Medical Center
Albany, New York, United States
Hospital for Special Surgery
New York, New York, United States
Countries
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References
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Frangiamore SJ, Saleh A, Grosso MJ, Alolabi B, Bauer TW, Iannotti JP, Ricchetti ET. Early Versus Late Culture Growth of Propionibacterium acnes in Revision Shoulder Arthroplasty. J Bone Joint Surg Am. 2015 Jul 15;97(14):1149-58. doi: 10.2106/JBJS.N.00881.
Pottinger P, Butler-Wu S, Neradilek MB, Merritt A, Bertelsen A, Jette JL, Warme WJ, Matsen FA 3rd. Prognostic factors for bacterial cultures positive for Propionibacterium acnes and other organisms in a large series of revision shoulder arthroplasties performed for stiffness, pain, or loosening. J Bone Joint Surg Am. 2012 Nov 21;94(22):2075-83. doi: 10.2106/JBJS.K.00861.
Saltzman MD, Nuber GW, Gryzlo SM, Marecek GS, Koh JL. Efficacy of surgical preparation solutions in shoulder surgery. J Bone Joint Surg Am. 2009 Aug;91(8):1949-53. doi: 10.2106/JBJS.H.00768.
Rao AJ, Chalmers PN, Cvetanovich GL, O'Brien MC, Newgren JM, Cole BJ, Verma NN, Nicholson GP, Romeo AA. Preoperative Doxycycline Does Not Reduce Propionibacterium acnes in Shoulder Arthroplasty. J Bone Joint Surg Am. 2018 Jun 6;100(11):958-964. doi: 10.2106/JBJS.17.00584.
Lee MJ, Pottinger PS, Butler-Wu S, Bumgarner RE, Russ SM, Matsen FA 3rd. Propionibacterium persists in the skin despite standard surgical preparation. J Bone Joint Surg Am. 2014 Sep 3;96(17):1447-50. doi: 10.2106/JBJS.M.01474.
Falconer TM, Baba M, Kruse LM, Dorrestijn O, Donaldson MJ, Smith MM, Figtree MC, Hudson BJ, Cass B, Young AA. Contamination of the Surgical Field with Propionibacterium acnes in Primary Shoulder Arthroplasty. J Bone Joint Surg Am. 2016 Oct 19;98(20):1722-1728. doi: 10.2106/JBJS.15.01133.
Canavan TN, Chen E, Elewski BE. Optimizing Non-Antibiotic Treatments for Patients with Acne: A Review. Dermatol Ther (Heidelb). 2016 Dec;6(4):555-578. doi: 10.1007/s13555-016-0138-1. Epub 2016 Aug 19.
Kolakowski L, Lai JK, Duvall GT, Jauregui JJ, Dubina AG, Jones DL, Williams KM, Hasan SA, Henn RF 3rd, Gilotra MN. Neer Award 2018: Benzoyl peroxide effectively decreases preoperative Cutibacterium acnes shoulder burden: a prospective randomized controlled trial. J Shoulder Elbow Surg. 2018 Sep;27(9):1539-1544. doi: 10.1016/j.jse.2018.06.012. Epub 2018 Jul 24.
Dai T, Gupta A, Murray CK, Vrahas MS, Tegos GP, Hamblin MR. Blue light for infectious diseases: Propionibacterium acnes, Helicobacter pylori, and beyond? Drug Resist Updat. 2012 Aug;15(4):223-36. doi: 10.1016/j.drup.2012.07.001. Epub 2012 Jul 28.
Kawada A, Aragane Y, Kameyama H, Sangen Y, Tezuka T. Acne phototherapy with a high-intensity, enhanced, narrow-band, blue light source: an open study and in vitro investigation. J Dermatol Sci. 2002 Nov;30(2):129-35. doi: 10.1016/s0923-1811(02)00068-3.
Ash C, Dubec M, Donne K, Bashford T. Effect of wavelength and beam width on penetration in light-tissue interaction using computational methods. Lasers Med Sci. 2017 Nov;32(8):1909-1918. doi: 10.1007/s10103-017-2317-4. Epub 2017 Sep 12.
Oplander C, Hidding S, Werners FB, Born M, Pallua N, Suschek CV. Effects of blue light irradiation on human dermal fibroblasts. J Photochem Photobiol B. 2011 May 3;103(2):118-25. doi: 10.1016/j.jphotobiol.2011.02.018. Epub 2011 Feb 26.
Other Identifiers
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5316
Identifier Type: -
Identifier Source: org_study_id
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