The impact of patient and surgical factors on the rate of infection after primary total knee arthroplasty

Tayton, Edward; Frampton, Chris; Hooper, Gary J.; Young, Simon W.

doi:10.1302/0301-620x.98b3.36775

Cited by 110 publications

(70 citation statements)

References 33 publications

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“…As a result of the relatively small number of THAs with ASA and BMI recording with followup longer than 6 months, we elected to exclude these two PJI risk parameters from the multivariate risk analysis. This is potentially important, because in some studies, the effect size of the increased risk of infection associated with higher BMIs and ASA classes [10,15] is comparable to the effect size we observed here in association with bearing surfaces. This suggests that some or all of the observed effect associated with bearing surface could have been the influence of those potentially confounding variables.…”

Section: Discussionsupporting

confidence: 82%

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Periprosthetic Joint Infection in Hip Arthroplasty: Is There an Association Between Infection and Bearing Surface Type?

Pitto

Sedel

2016

Clinical Orthopaedics &Amp; Related Research

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Background Preliminary studies have raised the question of whether certain prosthetic biomaterials used in total hip arthroplasty (THA) bearings are associated with increased risk of periprosthetic joint infection (PJI). For example, some observational data suggest the risk of PJI is higher with metal-on-metal bearings. However, it is not known whether other bearings-including ceramic bearings or metal-on-polyethylene bearings-may be associated with a higher or lower risk of PJI. Questions/purposes The objective of this study was to use a national arthroplasty registry to assess whether the choice of bearings-metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), ceramic-on-ceramic (CoC), or metal-on-metal (MoM)-is associated with differences in the risk of revision for deep infection, either (1) within 6 months or (2) over the entire period of observation, which spanned 15 years. Methods Data from primary THAs were extracted from the New Zealand Joint Registry over a 15-year period. A total of 97,889 hips were available for analysis. Inclusion criterion was degenerative joint disease; exclusion criteria were previous surgery, trauma, and any other diagnosis (12,566 hips). We also excluded a small group of ceramicon-metal THAs (429) with short followup. The median observation period of the selected group of hips (84,894) was 9 years (range, 1-15 years). The mean age of patients was 68 years (SD ± 11 years), and 52% were women. There were 54,409 (64%) MoP,16,503 (19%) CoP, 9051 (11%) CoC, and 4931 (6%) MoM hip arthroplasties. Four hundred one hips were revised for deep infection. A multivariate assessment was carried out including the following risks factors available for analysis: age, sex, operating room type, use of body exhaust suits, THA fixation mode, and surgeon volume.

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Section: Discussionsupporting

confidence: 82%

“…Because of this rather homogeneous practice, we elected to exclude the factor preoperative antibiotic prophylaxis from multivariate analysis. Also, operative time was not used for analysis; a recent Registry study showed no association with the risk of revision for PJI in TKA [15].…”

Section: Methodsmentioning

confidence: 99%

Periprosthetic Joint Infection in Hip Arthroplasty: Is There an Association Between Infection and Bearing Surface Type?

Pitto

Sedel

2016

Clinical Orthopaedics &Amp; Related Research

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“…Their multivariate analysis showed that using surgical helmet system has a trend towards significance for deep infection. They concluded that there is no evidence in favor of modern surgical helmet system decreasing PJI, they may even increase the risk of infection in primary TKR (14).…”

Section: Resultsmentioning

confidence: 99%

Role of Body Exhaust System in Reducing Peri-Prosthetic Joint Infection, Literature Review

Ghazavi

2016

Shafa Ortho J

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Context: There is a need to determine if body exhaust suits which were initially used and recommended by Sir John Charnley has a role in minimizing bacterial shedding in the operating room. Evidence Acquisition: The English literature search conducted for relevant articles. 14 articles were relevant to the role of body exhaust system in total joint replacement. Results: There is controversial evidences regarding the role of body exhaust system in reducing pei-prosthetic joint infection but most evidences agree that its role in protecting operating room personnel could not be denied. Conclusions:There is not enough evidence to indicate that use of body exhaust suits could reduce risk of infection, however there are some evidences showing increased protection of surgical team by using body exhaust system.

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“…Interestingly, recent data from the New Zealand Joint Registry and the Kaiser Joint Registry show similar findings. 5,6 This observation has previously attracted little attention. It can serve as fertile area for the generation and testing of hypotheses with more detailed research, and will hopefully lead to interventions that reduce the risk.…”

Section: Observationmentioning

confidence: 99%

Joint registries

Berry

2017

The Bone & Joint Journal

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AimsTo demonstrate, with concrete examples, the value of in-depth exploration and comparison of data published in National Joint Arthroplasty registry reports. Patients and MethodsThe author reviewed published current reports of National Joint Arthroplasty registries for findings of current significance to current orthopaedic practice. ResultsA total of six observations that demonstrate actionable or unexpected findings from joint registries are described. These include: one third to one half of all arthroplasty failures in the first decade occur in the first one to two years; infection rates after arthroplasty have not declined in the last three decades; infection after TKA is more common in men than women; outcomes of TKA are more variable in young compared with older patients; new technologies (uncemented implants and crosslinked polyethylene) have improved results of THA and a real-time shift in use of ceramic femoral heads is occurring in THA. ConclusionThese six observations may be used to better understand current practice, stimulate practice improvements or suggest topics for further study.

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The impact of patient and surgical factors on the rate of infection after primary total knee arthroplasty

Abstract: Infection rates in TKA are related to both individual patient and surgical factors, and some modern methods of reducing infection may actually increase infection risk.

Cited by 110 publications

References 33 publications

Periprosthetic Joint Infection in Hip Arthroplasty: Is There an Association Between Infection and Bearing Surface Type?

Periprosthetic Joint Infection in Hip Arthroplasty: Is There an Association Between Infection and Bearing Surface Type?

Role of Body Exhaust System in Reducing Peri-Prosthetic Joint Infection, Literature Review

Joint registries

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