Intraoperative contamination influences wound discharge and periprosthetic infection

Area of Science:

• Orthopedic Surgery
• Infectious Disease
• Surgical Microbiology

Background:

• Intraoperative bacterial contamination poses a risk for surgical site complications.
• The precise extent of this risk, particularly for prolonged wound discharge and periprosthetic infection following total hip arthroplasty, requires further elucidation.

Purpose of the Study:

• To investigate the association between intraoperative bacterial contamination of instruments and bone during primary total hip arthroplasty (THA).
• To determine if such contamination correlates with prolonged wound discharge and subsequent periprosthetic infection.

Main Methods:

• Prospective study involving 100 primary total hip arthroplasties.
• Intraoperative cultures were obtained from surgical instruments and removed bone.
• Postoperative wound discharge was monitored up to postoperative Day 5.
• Patients were followed for 2 years to assess for periprosthetic infection.

Main Results:

• Bacterial contamination was detected in 36% of procedures.
• Intraoperative contamination showed a significant association with prolonged wound discharge (relative risk = 2.5).
• Culturing removed bone demonstrated a high positive predictive value (81%-90%) for prolonged wound discharge.
• Rheumatoid arthritis (RR=6.4), use of cement (RR=1.6), and increased blood loss (RR=1.5) were also linked to prolonged discharge.

Conclusions:

• Intraoperative bacterial contamination during THA is a significant risk factor for prolonged wound discharge.
• Intraoperative bone culturing can effectively predict prolonged wound discharge.
• Identifying and mitigating intraoperative contamination may be crucial for improving wound healing outcomes in THA.