Infection of the surgical site after arthroplasty of the hip

Abstract

We wished to estimate the incidence of surgical-site infection (SSI) after total hip replacement (THR) and hemiarthroplasty and its strength of association with major risk factors. The SSI surveillance service prospectively gathered clinical, operative and infection data on inpatients from 102 hospitals in England during a four-year period. The overall incidence of SSI was 2.23% for 16,291 THRs, 4.97% for 5769 hemiarthroplasty procedures, 3.68% for 2550 revision THRs and 7.6% for 198 revision hemiarthroplasties. Staphylococcus aureus was identified in 50% of SSIs; 59% of these isolates were methicillin-resistant (MRSA). In the single variable analysis of THRs, age, female gender, American Society of Anesthesiologists (ASA) score, body mass index, trauma, duration of operation and pre-operative stay were significantly associated with the risk of SSI (p < 0.05). For hemiarthroplasty, the ASA score and age were significant factors. In revision THRs male gender, ASA score, trauma, wound class, duration of operation and pre-operative stay were significant risk factors. The median time to detection of SSI was eight days for superficial incisional, 11 days for deep incisional and 11 days for joint/bone infections. For each procedure the mean length of stay doubled for patients with SSI. The multivariate analysis identified age group, trauma, duration of operation and ASA score as significant, independent risk factors for SSI. There was significant interhospital variation in the rates of SSI. MRSA was the most common pathogen to cause SSI in hip arthroplasty, especially in patients undergoing hemiarthroplasty, but coagulase-negative Staph. aureus may be more important in deep infections involving the joint.

Relationship Between Perioperative Urinary Tract Infection and Deep Infection After Joint Arthroplasty

“…Few studies adhere to these criteria [3,30,35,37]. This requires 12-month followup and we were able to classify cases into deep and superficial infection based on the Centers for Disease Control and Prevention criteria.…”

“…The rate of joint infections in our patients is 0.29%. In the literature, the rates of joint infection range from 0.38% to 2.3% [28,35,39]. These data suggest treated UTI is a minimal risk factor for prosthetic joint infection.…”

“…Numerous authors have proposed theories [8,12,14,17,28,35,46,48] and risk factors [3,12,30,35] (Table 1) regarding the pathogenesis of infection after joint arthroplasty to prevent and control this condition. However, identification of risk factors often is difficult [3,18,27,30].…”

Prosthetic Joint Infection Risk after TKA in the Medicare Population

“…A recent study related to antibiotic-related bone cement, drawn in part from the European registry experience, noted a lack of controlled clinical trials related to the treatment of infection [14]. Despite these limitations, observational studies conducted over the past three decades suggest multiple factors may be implicated in the infection risk for patients undergoing arthroplasty, including increased operative time, longer hospital stay, obesity, simultaneous bilateral joint arthroplasty, and diagnoses of rheumatoid arthritis, myocardial infarction, and atrial fibrillation, and the lack of use of certain infection countermeasures such as antibiotic bone cement [6,14,17,18,21,23]. Thus, the current relative risk of infection in contemporary TKA as well as the relative importance of various risk factors remains under debate attributable both to the rarity of the complication, changes in the treatment and prevention of infection over time as well as the practical difficulties associated with conducting well-controlled clinical studies on this topic with long-term followup.…”

Does Preadmission Cutaneous Chlorhexidine Preparation Reduce Surgical Site Infections After Total Hip Arthroplasty?

“…Because the number of arthroplasties are only expected to increase, over the past 10 years, much has changed in the orthopaedic practice to decrease the odds for developing a postoperative infection, especially in the arthroplasty world [15,26]. Within these methods, laminar airflow, positive air pressure, and body exhaust suits have been proven to be effective [2,9,18,22,27,28]; however, these steps cannot reduce infections from the patient's skin flora [12].…”