Contamination of Irrigation Fluid During Primary Total Knee Arthroplasty

During surgical procedures, some amount of irrigation fluid leaks from the surgical site and accumulates on the sterile drapes. Whether these fluid collections show bacterial contamination over time in primary total knee arthroplasty remains unclear.

In this study, we included 100 patients. We collected the samples of irrigation fluid before skin incision and every 30 minutes after the start of surgery. In addition, at the end of surgery, we evaluated the suction tip for bacterial contamination. After 3 months, we clinically evaluated all patients for periprosthetic joint infection.

Although the drapes were found to be sterile after 30 minutes, fluid residues on the surgical drapes show a contamination rate of 22% after 60 minutes and thus a marked correlation between advanced duration of surgery and bacterial contamination. The suction tip was contaminated with bacteria in 22% of cases. The spectrum of pathogens typical of periprosthetic joint infection could be demonstrated.

Fluid surgical drape reservoirs were abacterial during the first 30 minutes but showed marked bacterial contamination over time. For total knee arthroplasty, we recommend regular replacement of the suction tip every 30 minutes. In addition, irrigation fluid reservoirs should not be withdrawn by suction 30 minutes after skin incision.