The Control of Infection Committee at a specialist orthopaedic hospital prospectively collected data on all episodes of bacteriologically-proven deep infection arising after primary hip and knee replacements over a 15-year period from 1987 to 2001. There were 10 735 patients who underwent primary hip or knee replacement. In 34 of 5947 hip replacements (0.57%) and 41 of 4788 knee replacements (0.86%) a deep infection developed. The most common infecting micro-organism was coagulase-negative staphylococcus, followed by Staphylococcus aureus, enterococci and streptococci. Of the infecting organisms, 72% were sensitive to routine prophylactic antimicrobial agents. Of the infections, 29% (22) arose in the first three months following surgery, 35% between three months and one year (26), and 36% (27) after one year. Most cases were detected early and treated aggressively, with eradication of the infection in 96% (72). There was no significant change in the infection rate or type of infecting micro-organism over the course of this study. These results set a benchmark, and importantly emphasise that only 64% of peri-prosthetic infections arise within one year of surgery. These results also illustrate the advantages of conducting joint replacement surgery in the isolation of a specialist hospital.

Forty-one consecutive patients with primary knee arthroplasty and 37 with primary hip arthroplasty, all with perioperative wound infections, were followed for 50 (12-130) months. Staphylococci (coagulase negative and positive) accounted for 74% of wound infections. Mixed organisms accounted for 10%. Prosthetic infections developed in eight patients and aseptic loosening in three patients. All the prosthetic infections developed within 6 months of the primary surgery. Organisms responsible for superficial infections were responsible for prosthetic infection in five patients; no organisms were isolated in the remaining three patients. The presence or absence of wound dehiscence, wound haematoma, and postoperative pyrexia did not predict the development of deep sepsis; however, the presence of wound discharge was a significant risk factor. Résumé Une série de patients consécutifs présentant une infection péri-opératopire ont été suivis pendant 50 (12 à 130) mois ; 41 après une arthroplastie primaire du genou et 37 après une arthroplastie primaire de la hanche. Le staphylocoque (coagulase positif et negatif) était en cause dans 74% des cas. Dans 10% des cas plusieurs germes étaient en cause. Les infections sur prothèse se sont développées chez huit patients et il y eu un descellement aseptique chez trois patients. Toutes les infections sur prothèse se sont développées dans les six mois suivant la chirurgie primaire. Les germes responsables des infections superficielles étaient responsables de l'infection sur prothèse chez cinq patients. Aucun germe n'a été isolé chez les trois autre patients. La présence d'une déhiscence de la plaie, l'existence d'un hématome ou la pyrexie postopératoires n'avaient pas de valeur prédictive pour le développement d'un sepsis profond mais la présence d'un écoulement de la plaie opératoire était un facteur de risque considérable.

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