Post-operative oral antibiotics and the risk for prosthetic joint infection in primary total shoulder arthroplasty: A matched cohort analysis.

Abstract

Prosthetic joint infection (PJI) is a serious complication following total shoulder arthroplasty (TSA). While extended postoperative oral antibiotic prophylaxis is increasingly used in hip and knee arthroplasty to reduce PJI risk, its role in TSA remains unclear. This study aimed to determine whether postoperative oral antibiotics impact infection and revision rates following primary TSA using a large national database. A retrospective cohort study was performed using the TriNetX database to identify patients who underwent primary TSA. Patients were divided into two cohorts based on whether they received a postoperative oral antibiotic prescription within one day of surgery. A one-to-one propensity score match was used to balance baseline characteristics. Outcomes assessed included risk of PJI, surgical site infection, readmission, and revision at 30 days, 90 days, 2 years, and final follow-up. After matching, 6434 patients were analyzed. No significant difference was observed in infection rates between groups at any time point. At final follow-up, PJI occurred in 2.4 % of patients who received antibiotics versus 2.2 % who did not (HR 1.141; 95 % CI, 0.906-1.437; p = 0.263). Revision rates were also similar: 4.5 % in the antibiotic group versus 4.0 % in the non-antibiotic group (HR 1.140; 95 % CI, 0.962-1.351; p = 0.131). Notably, patients receiving antibiotics had a significantly lower 30-day readmission rate (HR 0.726; 95 % CI, 0.594-0.887; p = 0.002). In this large matched cohort study, postoperative oral antibiotics did not significantly reduce the risk of infection or revision following TSA. However, a reduction in short-term readmissions was observed. These findings suggest limited benefit in infection prevention, and further randomized trials are warranted to clarify the role of postoperative oral antibiotics in TSA. Level III Retrospective Cohort Comparison Using Large Database Prognosis Study.