Surgical Helmet Systems Were Not Associated With Lower Operative Infection Rates After Total Ankle Arthroplasty: A...

BackgroundConflicting evidence exists regarding the ability of surgical helmet systems (SHSs) to reduce rates of infection after joint replacement. The purpose of this study was to investigate the use of SHS in total ankle arthroplasty (TAA) and their effect on postoperative infection rates.MethodsA retrospective cohort study was conducted on patients who underwent elective primary TAA between January 2013 and June 2023 in a US private academic setting to compare rates of surgical site infection with and without the use of an SHS. Demographic characteristics, revision rates, superficial and deep infection, and their respective operative or nonoperative treatment, patient-reported outcome measures (12-Item Short Form Health Survey physical component summary [PCS], Foot and Ankle Ability Measure [FAAM], visual analog scale [VAS]), and implant survivorship were collected and compared between groups.ResultsA total of 938 patients who underwent primary TAA at our institution were included in this study, with 496 (52.9%) in the hood group and 442 (47.1%) in the conventional gown group at a mean follow-up of 6.8 (range: 2-12.5) years. There were no significant differences found between the use of a surgical hood vs conventional gowning with regard to overall surgical site infection (5.24% vs 4.98%, P = .972) and deep prosthetic joint infection (2.62% vs 2.71%, P = 1.000). A multivariable logistic regression model controlling for age, body mass index, tobacco use, and diabetes found no association between the use of surgical hoods and surgical site infections after TAA (OR = 1.12, P = .710). Furthermore, no differences in FAAM, VAS, PCS, or implant survivorship were found between groups.ConclusionAlthough SHS may provide additional protection for the surgeon from being contaminated during the surgery, the use of surgical hoods was not associated with a protective effect against surgical site infection. Considering the disadvantages and added costs of SHS, the decision to wear hoods during TAA is therefore left to the individual surgeon's discretion and personal preference.