International Orthopaedics

, 31:27 | Cite as

Outcome following deep wound contamination in cemented arthroplasty

  • A. M. Byrne
  • S. Morris
  • T. McCarthy
  • W. Quinlan
  • J. M. O’Byrne
Original Paper

Abstract

Infection remains a devastating complication of joint replacement surgery causing a significant burden to both patient and surgeon. However, despite exhaustive prophylactic measures, intraoperative contamination still occurs during cemented arthroplasty with current infection rates of 1–2%. A study was undertaken to determine the incidence of perioperative contamination in cemented arthroplasty patients, to identify contaminating organisms, to identify contaminated regions within the operative wound, to identify factors associated with increased contamination, and finally to assess the medium-term clinical outcome in patients with confirmed intraoperative wound contamination. Eighty consecutive patients undergoing hip and knee cemented arthroplasty were prospectively enrolled over a 6-month period. All scrubbed personnel wore total body exhaust isolation suits and procedures were carried out in ultra-clean air theatres. Of 441 samples, contamination was identified at 21 sites (4.8%) representing a cohort of 18 patients (22.5%). Longer duration of surgery predisposed to higher contamination rates while lower contamination rates were significantly related to fewer gowned personnel within the ultra-clean system, and fewer total personnel in theatre during the procedure. None of the patients developed clinical evidence of deep prosthetic infection at follow-up. We noted a high incidence of intraoperative contamination despite standard prophylaxis. However, this was not reflected by a similar rate of postoperative infection. This may be due to a small bacterial inoculum in each case or may be due to the therapeutic effect of perioperative intravenous antibiotic prophylaxis.

Résumé

L’infection reste une complication grave de la chirurgie de remplacement articulaire et, en dépit des mesures prophylactiques, la contamination opératoire existe encore durant les arthroplasties cimentées avec un taux d’infection de 1 à 2%. Le but de ce travail était de déterminer l’incidence de cette contamination, d’identifier les micro-organismes en cause et les régions contaminées au sein du champ opératoire, de préciser les facteurs associés favorisant et enfin d’étudier le devenir à moyen terme des patients avec une contamination opératoire confirmée. Quatre-vingt patients consécutifs, opérés pour une arthroplastie cimentée de hanche ou de genou, étaient enrôlés prospectivement pendant une période de 6 mois. Tout le personnel habillé chirurgicalement portait un scaphandre isolant et l’opération se déroulait dans une enceinte à air ultra filtré. A partir de 441 échantillons une contamination était identifiée sur 21 sites (4,8%), représentant un groupe de 18 patients (22,5%). Une plus longue durée opératoire prédisposait à un plus grand taux de contamination. Un faible taux de contamination était significativement en relation avec un moindre nombre de personnes à l’intérieur de l’enceinte ultra-filtrée et avec un moindre nombre de personnes dans la salle d’opération pendant la réalisation de l’arthroplastie. Aucun patient n’avait développé d’infection profonde au dernier recul. Le taux élevé de contaminations opératoires malgré les précautions prophylactiques ne se retrouve pas dans un taux similaire d’infections post-opératoires. Ceci est peut-être due à la petitesse de l’inoculum bactérien dans chaque cas ou encore à l’effet thérapeutique de l’antibiothérapie prophylactique intra-veineuse.

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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • A. M. Byrne
    • 1
    • 2
  • S. Morris
    • 1
  • T. McCarthy
    • 1
  • W. Quinlan
    • 1
  • J. M. O’Byrne
    • 1
  1. 1.Cappagh National Orthopaedic HospitalDublinIreland
  2. 2.Glasnevin, DublinIreland

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