Use of Vancomycin Powder in Shoulder Arthroplasty: Preliminary Results
Orthopaedic Spot, 2026
Joana Maria Tavares Almeida 1, *, Maria J. Leite 1,2, Bernardo Nunes 1, Manuel R. Silva 2,3, Manuel Gutierres 1,3, João M. Torres 1,3
1 Orthopedics Department, São João University Hospital, Porto, Portugal
2 Orthopedics Department, CUF Porto Hospital, Porto, Portugal
3 Porto Medical School, Porto University, Porto, Portugal
* Corresponding Author: Joana Maria Tavares Almeida [joana17almeida17@gmail.com], Orthopedics Department, São João University Hospital, Alameda Professor Hernâni Monteiro, 4200?319 Porto, Portugal
Introduction: The use of intraoperative vancomycin powder as prophylaxis in spine surgery, as well as in knee and hip surgery, has been well established in the literature, but evidence is lacking regarding the role of its use in shoulder arthroplasty. This study aims to compare the infection rates between patients undergoing shoulder arthroplasty with intraoperative use of vancomycin powder and those managed with the standard protocol without local antibiotic application.
Methods: We designed a retrospective controlled study, including all patients submitted to shoulder arthroplasty in our Orthopedics Department between 2018 and 2020. We divided them into two groups: the intervention group, which received the powder, and a control group. The intervention technique consisted of using 1 g of vancomycin powder directly between all bone and metal interfaces and between all implant interfaces during surgery, and deeply into the muscular planes, before wound closure. Data contained in clinical files were collected, summarily, use of vancomycin powder, need for revision, and suspected infection, according to clinical and analytical criteria (EBJIS).
Results: Ninety?five patients were included, divided into an intervention group of 39 patients and a control group of 56 patients. Mean surgery duration in the study group was 103 ± 30 minutes, and in the control group was 145 ± 40 minutes (p>0.05). The rate of infection was 2.11%, occurring in the control group, concerning trauma cases. No infections were found in the vancomycin group. An association between infection and the absence of prophylactic vancomycin powder use was not statistically significant (p=0.514).
Conclusion: The use of local vancomycin powder might be a reasonable option for infection prevention in shoulder arthroplasty.
Keywords: Antibiotic Prophylaxis; Arthroplasty, Replacement, Shoulder; Postoperative Complications/prevention & control; Powders; Prosthesis?Related Infections/prevention & control; Shoulder Joint; Vancomycin/therapeutic use.
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