Visible glove perforation in total knee arthroplasty

Area of Science:

• Orthopedic Surgery
• Infection Control
• Biomedical Engineering

Background:

• Surgical site infections (SSI) and periprosthetic joint infections (PJI) are significant complications following total knee replacement (TKR).
• Glove perforation during surgery is a potential breach in sterile technique, but its association with infection risk is not well-established.

Purpose of the Study:

• To identify risk factors associated with glove perforation during primary TKR.
• To determine the risk of subsequent superficial SSI and PJI following intraoperative glove perforation.

Main Methods:

• A retrospective review of 1226 primary TKR procedures was conducted.
• A case-control analysis identified risk factors for glove perforation.
• Infection rates (SSI and PJI) were compared between groups with and without glove perforation.

Main Results:

• The overall glove perforation rate was 4.5% (55 out of 1226 knees).
• Identified risk factors for perforation included BMI > 30, bilateral surgery, operation time > 120 minutes, and non-trainee surgeons.
• Superficial SSI rates were significantly higher in the perforation group (9.15%) compared to the non-perforation group (0.51-0.55%).
• PJI rates did not differ significantly between the groups.
• The adjusted odds ratio for superficial SSI after perforation was 15.2.

Conclusions:

• Visible glove perforation during TKR is associated with specific patient and operative risk factors.
• Intraoperative glove perforation substantially increases the risk of superficial SSI following TKR.