Risk of surgical site infection associated with intraoperative smartphone use in a sterile cover during total knee...

Although the intraoperative use of smartphones enclosed in sterile covers has become popular in computer-assisted surgeries, smartphones can carry pathogenic bacteria. This study aimed to investigate whether the intraoperative use of a smartphone is associated with an increased risk of surgical site infection (SSI) following primary total knee arthroplasty (TKA).

We retrospectively reviewed 1,223 consecutive primary TKAs. Smartphones enclosed in sterile covers were directly used by the surgeon in 328 TKAs, whereas 895 TKAs were performed without smartphone use. One-to-two propensity score matching was performed based on age, sex, body mass index, diagnosis, history of diabetes mellitus, operative time, operative period, and preoperative range of knee motion, yielding a matched cohort of 276 TKAs performed with intraoperative smartphone use and 552 controls. The primary outcome was SSI, defined as the periprosthetic joint infection within one year after TKA.

After propensity score matching, all baseline covariate imbalances were adequately minimized (standardized mean differences < 0.10). The SSI rate was 0.7% (2 of 276 knees) in the smartphone group and 0.9% (5 of 552 knees) in the control group (odds ratio, 0.80; 95% confidence interval, 0.08-4.92; p > 0.99).

Intraoperative use of a smartphone enclosed in a sterile cover during primary TKA was not associated with a detectable increased risk of postoperative SSI. The findings may contribute to the clinical implementation of smartphone-aided computer-assisted surgery.