Subcutaneous lavage with a 0.05% chlorhexidine gluconate solution leads to decreased Cutibacterium acnes deep culture rate in primary total shoulder arthroplasty: a prospective, randomized controlled trial.

Summary

In a single-blinded RCT (n=126), subcutaneous lavage with 0.05% chlorhexidine during primary shoulder arthroplasty halved the odds of deep C. acnes contamination compared with saline (OR 2.21 for saline vs CHG; stronger effect in males, OR 2.84). Findings support adding subcutaneous CHG irrigation to intraoperative antisepsis protocols.

Key Findings

• Single-blinded RCT with 126 patients randomized to saline vs 0.05% CHG subcutaneous irrigation.
• Saline irrigation more than doubled the odds of deep C. acnes contamination compared with CHG (OR 2.21, 95% CI 1.12–4.37).
• In males, the elevated risk with saline was even greater (OR 2.84, 95% CI 1.25–6.48).
• Cultures were incubated for 21 days; study powered at 85% with alpha 0.05.

Clinical Implications

Consider incorporating 0.05% chlorhexidine subcutaneous lavage after incision during primary shoulder arthroplasty to reduce deep C. acnes contamination; findings may also inform antisepsis strategies in other implant or aesthetic surgeries with C. acnes risk.

Limitations

• Single-surgeon, single-center limits generalizability
• Primary outcome is microbiological contamination, not clinical infection rates

Future Directions

Multicenter trials to assess clinical infection outcomes and evaluate applicability to other surgeries (e.g., implants, aesthetic procedures) and optimal CHG concentrations.