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[Possible routes of infection in hip replacement]
V A Shilnikov1, A D Sineoky1, A A Kochish1
1Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russia.
Objective:
To evaluate the probability of direct inoculation of pathogens into the bone bed by surgical instruments and implants.
Material And Methods:
The study included 22 patients who underwent surgery at the Vreden National Medical Research Center of Traumatology and Orthopedics. Mean age was 73.3±3.7 years. These patients underwent total hip replacement. Intraoperative skin scrapings within the wound edge were made. Pressure on the scalpel was applied in two fashions. In 10 cases, scraping was performed by minimally pressure on the skin (superficial contact). In 12 cases, scalpel was pressed with force (skin deformation to a depth of 3-4 mm). Next, microbiological analysis of scrapings was performed.
Results:
There was no growth of microorganisms in samples obtained by minimal pressure on the scalpel. Analysis of 12 scrapings in the second group (tight contact simulating damage to the skin with surgical instruments) revealed growth of microflora in all cases.
Conclusion:
Contact of cutters, rasps and implants with skin can be a mechanism for direct inoculation of pathogens into the bone tissue and potentially cause periprosthetic infection.
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