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Trial registered on ANZCTR
Registration number
ACTRN12618000530224p
Ethics application status
Submitted, not yet approved
Date submitted
28/03/2018
Date registered
10/04/2018
Date last updated
30/04/2018
Type of registration
Prospectively registered
Titles & IDs
Public title
Intraosseous Administration of Prophylactic Cefazolin in Total Shoulder Arthoplasty
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Scientific title
Local Tissue Concentrations Following Intraosseous Administration of Prophylactic Cefazolin in Total Shoulder Arthoplasty
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Secondary ID [1]
294465
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None
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Universal Trial Number (UTN)
U1111-1211-4620
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Deep Prosthesis Infection Prevention
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Condition category
Condition code
Musculoskeletal
306336
306336
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0
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Osteoarthritis
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Infection
306337
306337
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0
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Other infectious diseases
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Intraosseous prophylactic cefazolin administration in total shoulder arthroplasty
Once off 2g cefazolin <1min prior to skin incision by intraosseous cannula inserted by surgeon into greater tuberosity of humerus in addition to 600mg of Lincamycin administered IV 60-30min prior to skin incision by anaesthetist
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Intervention code [1]
300758
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Treatment: Drugs
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Intervention code [2]
300824
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Prevention
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Comparator / control treatment
Intravenous prophylactic cefazolin administration in total shoulder arthroplasty
Once off 2g Cefazolin 60-30mins prior to skin incision by anaesthetist in addition to 600mg of Lincamycin administered at the same time
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Control group
Active
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Outcomes
Primary outcome [1]
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HPLC of cancellous bone and subcutaneous fat analysing cefazolin concentrations
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Assessment method [1]
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Timepoint [1]
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Skin incision - Fat
Humeral head removal - Bone + fat
Glenoid reaming - Bone + fat
Prior to closure - Fat
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Secondary outcome [1]
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Rate of post-operation infection reported via health staff to ensure safety
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Assessment method [1]
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Timepoint [1]
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Throughout standard post operation follow up daily until discharge then at 2 weeks, 6 months and 1 year post operation in private rooms unless subject is otherwise worried at which point they will be seen
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Eligibility
Key inclusion criteria
Patients undergoing total shoulder arthroplasty at St Andrew's Hospital Ipswich by Dr Mark Shillington.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
BMI >35, Allergy to antibiotics used in study, Abnormal liver or renal function, Recent <1 week antibiotic treatment, Previous compartment syndrome
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Study design
Purpose of the study
Prevention
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
Central randomisation by computer and placed in sealed opaque envelopes
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
Simple randomisation using computer generated random allocations
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Masking / blinding
Blinded (masking used)
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Who is / are masked / blinded?
The people assessing the outcomes
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Intervention assignment
Parallel
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Safety/efficacy
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Statistical methods / analysis
Priori power analysis to determine number of participants required - Based on previous cefazolin levels in knee tissue after intraosseous administration
Mean cefazolin concentrations of tissue samples will be calculated with confidence intervals and standard deviations
Significance and repeated-measures analysis of variance will be used to compare cefazolin concentrations
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
3/05/2018
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Actual
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Date of last participant enrolment
Anticipated
30/01/2020
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Actual
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Date of last data collection
Anticipated
29/01/2021
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Actual
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Sample size
Target
60
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
QLD
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Recruitment hospital [1]
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St Andrew's - Ipswich Private Hospital - Ipswich
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Recruitment postcode(s) [1]
22233
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4305 - Ipswich
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Funding & Sponsors
Funding source category [1]
299088
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Self funded/Unfunded
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Name [1]
299088
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Matthew Belford
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Address [1]
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2 Gray St, Ipswich, QLD, 4305
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Country [1]
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Australia
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Funding source category [2]
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Hospital
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Name [2]
299147
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St Andrew's Hospital
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Address [2]
299147
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Roderick St, IPSWICH QLD 4305
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Country [2]
299147
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Australia
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Funding source category [3]
299148
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Self funded/Unfunded
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Name [3]
299148
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Dr Mark Shillington
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Address [3]
299148
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2 Gray St, IPSWICH QLD 4305
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Country [3]
299148
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Australia
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Primary sponsor type
Individual
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Name
Matthew Belford
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Address
Westside Orthopaedics & Sports Medicine, 2 Gray St, Ipswich, QLD 4305
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Country
Australia
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Secondary sponsor category [1]
298339
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None
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Name [1]
298339
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Address [1]
298339
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Country [1]
298339
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Ethics approval
Ethics application status
Submitted, not yet approved
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Ethics committee name [1]
300025
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Human Research Ethics Committee - Greenslopes Private Hospital
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Ethics committee address [1]
300025
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Greenslopes Private Hospital, Newdegate St, Greenslopes QLD 4120
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Ethics committee country [1]
300025
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Australia
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Date submitted for ethics approval [1]
300025
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30/03/2018
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Approval date [1]
300025
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Ethics approval number [1]
300025
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Summary
Brief summary
Aim: To determine whether intraosseous (IO) administration of prophylactic cefazolin achieves higher tissue concentrations than IV administration in total shoulder arthroplasty. Relevance: Propionibacterium Acnes has been shown to be responsible for up to 56% of shoulder infections after orthopaedic implant. Recently papers came out revealing that higher cefazolin and vancomycin concentrations were found in tissue after IO administration rather than IV. This was associated with less colony forming units in a murine model and thus theoretically more effective at reducing infection rates. This was also the case in revision TKA where the tourniquet is down for significant periods. As such, we aim to determine whether this is the case in TSA where no tourniquet is used. Design: Randomised Control Trial Method: Patients undergoing TSA will be randomly allocated to either IV or IO prophylactic antibiotic administration groups using computer generated random allocations placed in numbered, opaque, sealed envelopes. Patients will be randomised in the pre-operative area to allow appropriate setup in the operative room. Upon signing consent, the patients will be asked to complete a demographics survey. The data collected from this survey will be filed electronically using numbers for patients, the number each patient is assigned will be filed safely. Both IV and IO groups will receive 600mg of Lincomycin as per usual TSA prophylaxis. The IV group will receive 1g Cefazolin at this time (60-30mins prior to incision). The IO group will receive 1g Cefazolin as a bolus in 50mL through in intraosseous cannula, placed in the greater tuberosity of the humerus, after draping and before skin incision. The cannula will be removed and skin incision will follow immediately (<1min). TSA will proceed as usual and cancellous bone and subcutaneous fat samples will be taken at the following four steps. First subcutaneous fat sample immediately after skin incision, then cancellous bone and subcutaneous fat samples at the time of humeral head removal and glenoid reaming, and the final subcutaneous fat sample immediately before closure. It should be noted that 0.5-1cm2 of each sample will be placed into sterile 15mL tubes kept in ice and water within a biochemical container. The bone samples will come from bone that is removed usually during TSA. A total of two bone samples and four fat samples will be taken from each patient. Patients will be monitored and followed up as per normal TSA protocol. The biochemical container will be kept in -80-90 degrees Celsius to ensure degradation of cefazolin does not occur prior to analysis. The biochemical container will be transported to Griffith University Gold Coast where analysis via high performance liquid chromatography will be used to determine the cefazolin concentrations of the samples. The laboratory staff will only know the number that the samples belong to and no patient information or the group they belong to will be known.
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Trial website
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Trial related presentations / publications
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Public notes
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Contacts
Principal investigator
Name
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Mr Matthew Belford
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Address
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Westside Orthopaedics & Sports Medicine, 2 Gray St, Ipswich, QLD, 4310
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Country
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Australia
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Phone
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+61 07 3819 0044
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Fax
82298
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+61 07 3819 0088
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Email
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[email protected]
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Contact person for public queries
Name
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Matthew Belford
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Address
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Westside Orthopaedics & Sports Medicine, 2 Gray St, Ipswich, QLD, 4310
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Country
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Australia
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Phone
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+61 07 3819 0044
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Fax
82299
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+61 07 3819 0088
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Email
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[email protected]
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Contact person for scientific queries
Name
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Matthew Belford
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Address
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Westside Orthopaedics & Sports Medicine, 2 Gray St, Ipswich, QLD, 4310
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Country
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Australia
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Phone
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+61 07 3819 0044
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Fax
82300
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+61 07 3819 0088
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Email
82300
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[email protected]
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No information has been provided regarding IPD availability
What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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