Outcome following deep wound contamination in cemented arthroplasty

Area of Science:

• Orthopedic Surgery
• Infectious Disease Control
• Biomedical Engineering

Background:

• Joint replacement surgery is susceptible to infection, a significant complication despite prophylactic measures.
• Current infection rates for cemented arthroplasty range from 1-2%, indicating persistent intraoperative contamination challenges.

Purpose of the Study:

• To determine the incidence and sources of perioperative contamination in cemented arthroplasty.
• To identify factors influencing contamination rates.
• To evaluate the clinical outcomes of patients with intraoperative contamination.

Main Methods:

• Prospective enrollment of 80 patients undergoing cemented hip and knee arthroplasty over 6 months.
• Utilized total body exhaust isolation suits and ultra-clean air theaters for all procedures.
• Collected 441 samples to identify contamination incidence, organisms, and locations.

Main Results:

• Intraoperative contamination was detected in 22.5% of patients (21 of 441 samples).
• Longer surgery duration correlated with higher contamination rates.
• Reduced contamination was associated with fewer gowned personnel and fewer total personnel in the operating theater.

Conclusions:

• A high incidence of intraoperative contamination occurs in cemented arthroplasty, even with stringent protocols.
• Perioperative contamination did not translate to deep prosthetic infections in this cohort.
• Potential factors mitigating infection include small bacterial load or antibiotic prophylaxis effectiveness.