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Investigation of Intraoperative Bacterial Contamination in Surgical Instruments Used for Total Hip Arthroplasty
Akihito Oya1,2, Noboru Matsumura1,2, Atsuhiro Fujie1
1Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
Background:
Reusing surgical instruments during simultaneous bilateral total hip arthroplasty (THA) may reduce direct costs but may increase the risk of periprosthetic joint infections, particularly through femoral broaches used for canal preparation. This study investigated potential bacterial contamination of surgical instruments to assess the safety of their reuse.
Methods:
Seventy-eight primary THA cases (15 males, 63 females; mean age, 63.8 ± 11.2 years) performed between January 2021 and October 2022 were analyzed. This prospective study evaluated bacterial contamination of the femoral broach during THA. In cases of simultaneous bilateral procedures, sampling was conducted after completion of the first-operated side. Patients were categorized according to operative duration (<90 minutes vs ≥ 90 minutes) using a predefined cutoff based on previous literature. Additional comparisons were made between culture-positive and culture-negative groups.
Results:
Bacterial contamination was detected in 3 cases (3.8%), all involving skin commensals (Staphylococcus capitis or Micrococcus luteus), with no periprosthetic joint infections reported. All positive cultures occurred in the short-time group. Operative time showed no association with contamination, whereas body weight and body mass index were significantly higher among culture-positive patients.
Conclusions:
Although no clinically significant infections occurred, bacterial contamination of surgery instruments was observed. Reusing a single instrument set may be safe with strict infection control measures; however, additional vigilance is warranted for obese patients due to their higher contamination risk.
Insights
Reusing surgical instruments for bilateral hip replacements is generally safe, but obese patients may have a higher risk of contamination. Strict infection control is essential.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Control
- Surgical Instrumentation
Background:
- Reusing surgical instruments in bilateral total hip arthroplasty (THA) can lower costs but may increase infection risks.
- Femoral broaches, used in canal preparation, are a potential source of periprosthetic joint infections.
Purpose of the Study:
- To evaluate the safety of reusing surgical instruments during simultaneous bilateral total hip arthroplasty.
- To assess the bacterial contamination of femoral broaches in THA procedures.
Main Methods:
- Prospective analysis of 78 primary THA cases (January 2021-October 2022).
- Bacterial sampling of femoral broaches after the first hip in bilateral procedures.
- Categorization by operative duration (<90 min vs. ≥90 min) and comparison between culture-positive and negative groups.
Main Results:
- Bacterial contamination (skin commensals) was found in 3.8% of cases.
- No periprosthetic joint infections were reported.
- Higher body weight and BMI were associated with positive cultures, not operative time.
Conclusions:
- While instrument reuse appears safe with stringent controls, bacterial contamination can occur.
- Obese patients present a higher risk for contamination, requiring increased vigilance.
- Strict infection control measures are crucial for safe surgical instrument reuse in THA.