Original Article

HSS Journal ®

, Volume 10, Issue 1, pp 45-51

First online:

Prevention of Surgical Site Infection in Total Joint Arthroplasty: An International Tertiary Care Center Survey

  • Benjamin F. RicciardiAffiliated withDepartment of Orthopedic Surgery, Hospital for Special Surgery Email author 
  • , Mathias P. BostromAffiliated withDepartment of Orthopedic Surgery, Hospital for Special Surgery
  • , Lars LidgrenAffiliated withDepartment of Orthopedics Clinical Sciences Lund, Lund UniversityThe Swedish Knee Arthroplasty Register
  • , Jonas RanstamAffiliated withDepartment of Orthopedics Clinical Sciences Lund, Lund UniversityNational Musculoskeletal Competence Centre
  • , Katharina M. D. MerolliniAffiliated withInstitute of Health and Biomedical Innovation, Queensland University of Technology
  • , Annette W-DahlAffiliated withDepartment of Orthopedics Clinical Sciences Lund, Lund UniversityThe Swedish Knee Arthroplasty Register

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Prevention strategies are critical to reduce infection rates in total joint arthroplasty (TJA), but evidence-based consensus guidelines on prevention of surgical site infection (SSI) remain heterogeneous and do not necessarily represent this particular patient population.


What infection prevention measures are recommended by consensus evidence-based guidelines for prevention of periprosthetic joint infection? How do these recommendations compare to expert consensus on infection prevention strategies from orthopedic surgeons from the largest international tertiary referral centers for TJA?

Patients and Methods

A review of consensus guidelines was undertaken as described by Merollini et al. Four clinical guidelines met inclusion criteria: Centers for Disease Control and Prevention's, British Orthopedic Association, National Institute of Clinical Excellence's, and National Health and Medical Research Council's (NHMRC). Twenty-eight recommendations from these guidelines were used to create an evidence-based survey of infection prevention strategies that was administered to 28 orthopedic surgeons from members of the International Society of Orthopedic Centers. The results between existing consensus guidelines and expert opinion were then compared.


Recommended strategies in the guidelines such as prophylactic antibiotics, preoperative skin preparation of patients and staff, and sterile surgical attire were considered critically or significantly important by the surveyed surgeons. Additional strategies such as ultraclean air/laminar flow, antibiotic cement, wound irrigation, and preoperative blood glucose control were also considered highly important by surveyed surgeons, but were not recommended or not uniformly addressed in existing guidelines on SSI prevention.


Current evidence-based guidelines are incomplete and evidence should be updated specifically to address patient needs undergoing TJA.


prosthetic joint infection international survey infection prevention strategies