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Does laminar airflow make a difference to the infection rates for lower limb arthroplasty: a study using the National Joint Registry and local surgical site infection data for two hospitals with and without laminar airflow

  • Original Article • HIP - INFECTION
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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

An Erratum to this article was published on 07 November 2016

Abstract

This study compared the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) data for total hip replacements (THRs) and total knee replacements (TKRs) from Hospital A [with laminar airflow (LAF)] and Hospital B (without LAF). These hospitals were originally managed by two different trusts that subsequently merged. Consequently, the theatres in Hospital A have always had LAF and those in Hospital B had only conventional ventilation systems. As this merger happened before the establishment of the NJR, it puts us in a unique position, enabling direct comparison of the revision rates for infected hip and knee replacements between the two hospitals that follow similar infection protocols. Analysis of the NJR data showed there were no statistical differences. Of the 2234 TKRs performed at Hospital A, 16 were revised for infection, whereas 19 of the 3694 TKRs at Hospital B were revised (p < 0.33). Of the 1752 THRs at Hospital A, 5 were revised for infection, whereas this was the case for 12 of the 3163 THRs at Hospital B (p < 0.59). There was also no statistical difference when combining the figures for TKRs and THRs (p < 0.59). Our local surgical site infection (SSI) data from these two hospitals were also analysed. Again, there was no statistical difference between the two sites (p < 0.34). Using LAF has not reduced the rate of revision for infection nor it has reduced the incidence of SSI in our theatres. This is the first study comparing infection rates in two different hospitals serving similar patient populations using the NJR and SSI data. Our study questions the rationale of increasing use of LAF in routine lower limb arthroplasty. We call for greater debate and more robust studies on the subject.

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Acknowledgements

We thank the patients and staff of all the hospitals in England, Wales and Northern Ireland who have contributed data to the National Joint Registry. We are grateful to the Healthcare Quality Improvement Partnership (HQIP), the NJR Research Sub-committee and staff at the NJR Centre for facilitating this work. We also thank Mr Paul Bassett and Ms Tara Nikovskis for their help with the statistics and with editing the manuscript, respectively. We thank the Editor of the Annals of the Royal College of Surgeons for giving us the permission to use our SSI data previously published in this journal. The authors have conformed to the NJR’s standard protocol for data access and publication. The views expressed represent those of the authors and do not necessarily reflect those of the National Joint Registry Steering Committee or the Health Quality Improvement Partnership (HQIP) who do not vouch for how the information is presented.

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Authors and Affiliations

  1. Department of Orthopaedics, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Ashford, Kent, TN24 0LZ, UK

    S. Singh, S. Reddy & Raj Shrivastava

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  1. S. Singh
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  2. S. Reddy
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  3. Raj Shrivastava
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Correspondence to Raj Shrivastava.

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The authors declare that they have no conflicts of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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In the original publication of this article, the family name of corresponding author has been published incorrectly; this error has now been corrected.

An erratum to this article is available at http://dx.doi.org/10.1007/s00590-016-1875-7.

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Singh, S., Reddy, S. & Shrivastava, R. Does laminar airflow make a difference to the infection rates for lower limb arthroplasty: a study using the National Joint Registry and local surgical site infection data for two hospitals with and without laminar airflow. Eur J Orthop Surg Traumatol 27, 261–265 (2017). https://doi.org/10.1007/s00590-016-1852-1

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  • DOI: https://doi.org/10.1007/s00590-016-1852-1

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