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Contamination Rate of Burnt Necrotic Tissue after Electrocoagulation in Total Knee Arthroplasty
Piti Rattanaprichavej1, Artit Laoruengthana1, Monton Galassi1
1Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.
Background:
Periprosthetic joint infection (PJI) is one of the commonly found catastrophic complications after total knee arthroplasty (TKA). Preoperative antibiotic prophylaxis, proper skin cleansing, shortened operative time, and sterility of surgical field and equipment are essential to minimize the risk of PJI. Although bacterial contamination of electrocautery tips has been reported, contamination of residual product of electrocoagulation, burnt necrotic tissue (BNT), is not well known. Therefore, we aimed to assess the contamination rate of BNT and association between contaminated BNT and PJI, and risk factors.
Methods:
BNTs from 183 patients who had undergone unilateral primary TKA at our institution were retrospectively analyzed. In each patient, three to five specimens of BNT were routinely collected in the operative field of primary TKA. Collecting time was defined as the duration from start of using the electrocautery device to the first collection of BNT.
Results:
Culture was positive in eight of 183 patients (4.4%; contaminated BNT group), and the most commonly isolated organism was coagulase-negative Staphylococcus (62.5%). The average operative time was 103.1 ± 44.2 minutes in the contaminated BNT group and 79.0 ± 16.7 minutes in the non-contaminated BNT group (p = 0.17), and collecting time was 48.0 ± 44.3 minutes and 29.7 ± 17.0 minutes (p = 0.28), respectively. None of the patients with contaminated BNT developed PJI, whereas four patients with culture-negative BNT developed PJI within 2 postoperative years.
Conclusions:
BNT in surgical field can become a reservoir of contaminating bacteria. However, contamination of BNT was not associated with PJI. Therefore, routine removal of all BNTs may be unnecessary.
Insights
Burnt necrotic tissue (BNT) in knee surgery can harbor bacteria, but its contamination does not increase the risk of periprosthetic joint infection (PJI). Routine removal of all BNT may not be necessary to prevent PJI after total knee arthroplasty (TKA).
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Surgical Microbiology
Background:
- Periprosthetic joint infection (PJI) is a serious complication following total knee arthroplasty (TKA).
- Bacterial contamination of surgical sites, including electrocautery tips, is a known risk factor.
- The role of burnt necrotic tissue (BNT) as a potential reservoir for bacterial contamination in TKA is not well understood.
Purpose of the Study:
- To determine the contamination rate of BNT in TKA procedures.
- To investigate the association between contaminated BNT and the development of PJI.
- To identify potential risk factors related to BNT contamination.
Main Methods:
- Retrospective analysis of BNT specimens from 183 patients undergoing primary TKA.
- Routine collection of 3-5 BNT specimens per patient during surgery.
- Correlation of BNT culture results with PJI development within two years postoperatively.
Main Results:
- Bacterial contamination was found in 4.4% of BNT specimens, with coagulase-negative Staphylococcus being the most common isolate.
- No patients with contaminated BNT developed PJI.
- Four patients with culture-negative BNT developed PJI, suggesting other sources of infection.
Conclusions:
- BNT can serve as a reservoir for bacteria during TKA.
- Contamination of BNT was not found to be a significant risk factor for developing PJI.
- Routine removal of all BNT may not be essential for PJI prevention in TKA.
