Zero surgical site infection in primary knee arthroplasty with multidisciplinary intervention: is it possible?

Surgical site infections (SSI) are among the most important complications in knee arthroplasty. In this article we aim to retrospectively evaluate effects of preoperative multidisciplinary assessment and treatment of focal infections in primary knee arthroplasty patients operated by a single surgeon in a single center. A total of 93 patients undergoing 120 primary knee arthroplasty operations were included in the study. In the preoperative assessment all patients were consulted by infectious diseases, otorhinolaryngology (ENT) and dentistry departments, and female patients additionally by gynecology departments to evaluate and treat possible focal infections. Decolonization protocols were implemented for the bacterial growths detected in nasal and urine cultures. Patients received one of four surgical interventions, namely unilateral total knee arthroplasty (TKA), unilateral robotic-assisted unicompartmental knee arthroplasty (RUKA), bilateral RUKA or unilateral TKA and unilateral RUKA. No patients received bilateral TKA in a single session. Out of 93 patients 70 (75.3%) were female, mean age was 67.7 ± 9.9 years, and American Society of Anesthesiologists (ASA) scores were < 3 for 93.5% of the study group. Fifty-two (55.9%) of the patients received RUKA. Mean value for the duration of operations was 150.7 ± 67 minutes, for hospitalization it was 5.9 ± 2.8 days, and postoperative follow-up was 25.7 ± 8.8 months. None of the patients developed SSI in the follow-up period. Many factors are associated with SSI after knee arthroplasty. Total absence of SSI in our study group may be attributable to meticulous patient selection, multidisciplinary preoperative assessment, and the performance of RUKA by a single surgeon in a single center.