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Background Periprosthetic joint infection (PJI) is a challenging complication associated with total joint arthroplasty (TJA). Traffic in the operating room (OR) increases bacterial counts in the OR, and may lead to increased rates of infection. Question/purposes Our purposes were to (1) define the incidence of door opening during primary and revision TJA, providing a comparison between the two types of procedures, and (2) identify the causes of door opening in order to develop a strategy to reduce traffic in the operating room. Methods An observer collected data during 80 primary and 36 revision TJAs. Surgeries were performed under vertical, laminar flow. Operating room personnel were unaware of the observer, thus removing bias from traffic. The observer documented the number, reason, and personnel involved in the event of a door opening from time of tray opening to closure of the surgical site.Results The average operating time for primary and revision procedures was 92 and 161 minutes, respectively. Average door openings were 60 in primary cases and 135 in revisions, yielding per minute rates of 0.65 and 0.84, respectively. The circulating nurse and surgical implant representatives constituted the majority of OR traffic. Conclusions Traffic in the OR is a major concern during TJA. Revision cases demonstrated a particularly high rate of traffic. Implementation of strategies, such as storage of instruments and components in the operating room and education of OR personnel, is required to reduce door openings in the OR.

The ability of uncemented femoral stems to osseointegrate properly depends largely on their fit in the proximal femur. We evaluated the topography of the proximal femur and determined differences based on age and sex. Retrospectively, anteroposterior radiographs from 312 (168 male, 144 female) pre-operative total hip arthroplasty (THA) patients (age of 21-85 years) were collected. Radiographic measurements were taken at 10 mm intervals along the length of the femur. Variables including canal flare index (CFI) and cortical index (CI) were calculated. Data were binned into three age groups and separated by sex for comparison. Measurements showed that CFI decreased with age for both sexes; however, females demonstrated a greater decrease. Decrease in flare occurred primarily on the lateral side. CI also decreased with age, the most pronounced drop occurring in older females. A clear difference exists between male and female proximal femoral geometry. This decrease is most likely attributed to the loss of cortical bone. The medial component likely demonstrates less loss of flare due to strong compressive forces that are transmitted through this portion of the femur. These results demonstrate the necessity of considering age and sex when selecting a proper prosthesis. ß