Clinical Orthopaedics and Related Research®

, Volume 470, Issue 10, pp 2690–2694 | Cite as

Operating Room Traffic is a Major Concern During Total Joint Arthroplasty

  • Pedram Panahi
  • Mitchell Stroh
  • David S. Casper
  • Javad Parvizi
  • Matthew S. Austin
Symposium: 2011 Musculoskeletal Infection Society



Periprosthetic joint infection (PJI) is a challenging complication associated with total joint arthroplasty (TJA). Traffic in the operating room (OR) increases bacterial counts in the OR, and may lead to increased rates of infection.


Our purposes were to (1) define the incidence of door opening during primary and revision TJA, providing a comparison between the two types of procedures, and (2) identify the causes of door opening in order to develop a strategy to reduce traffic in the operating room.


An observer collected data during 80 primary and 36 revision TJAs. Surgeries were performed under vertical, laminar flow. Operating room personnel were unaware of the observer, thus removing bias from traffic. The observer documented the number, reason, and personnel involved in the event of a door opening from time of tray opening to closure of the surgical site.


The average operating time for primary and revision procedures was 92 and 161 minutes, respectively. Average door openings were 60 in primary cases and 135 in revisions, yielding per minute rates of 0.65 and 0.84, respectively. The circulating nurse and surgical implant representatives constituted the majority of OR traffic.


Traffic in the OR is a major concern during TJA. Revision cases demonstrated a particularly high rate of traffic. Implementation of strategies, such as storage of instruments and components in the operating room and education of OR personnel, is required to reduce door openings in the OR.



The authors would like to thank Ranna Jaraha for her help with data collection.


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Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Pedram Panahi
    • 1
  • Mitchell Stroh
    • 1
  • David S. Casper
    • 1
  • Javad Parvizi
    • 1
  • Matthew S. Austin
    • 1
  1. 1.The Rothman Institute of OrthopaedicsThomas Jefferson University HospitalPhiladelphiaUSA

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