Airborne Contamination in Orthopedic Surgery

Franco, Jorge A.; Baer, Herman; Enneking, William F.

doi:10.1097/00003086-197701000-00035

Cited by 5 publications

(2 citation statements)

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“…Although patients with megaprostheses are still at high risk of developing PJI, several improvements have been introduced in the last decades. These include use of bactericidal coating materials in megaprostheses [43], use of laminar air flow and aspiration suits intraoperatively to minimize airborne bacterial contamination [44], and enhanced soft tissue coverage techniques [39]. Finally, the prophylactic antibiotic regimens in tumor surgery (PARITY) demonstrated that the prolonged used of post-operative antibiotics beyond one day did not reduce the surgical site infection rate; rather, it increased the risk of antibiotic-related complications, with C. difficile colitis being the most prevalent (16%) [38].…”

Section: Risk Of Pji In Megaprosthesismentioning

confidence: 99%

Risk Factors and Management of Prosthetic Joint Infections in Megaprostheses—A Review of the Literature

Gonzalez,

Pretell-Mazzini,

Lozano-Calderon

2023

Antibiotics

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Prosthetic joint infection (PJI) is the most common mode of failure of megaprostheses, yet the literature on the topic is scarce, and studies report conflicting data regarding the optimal treatment strategy. Patients with megaprostheses PJI are often immunosuppressed, and surgeons must balance the trade-off between treatment efficacy and morbidity associated with the surgery aiming for infection eradication. Our review on megaprostheses PJI focuses on two axes: (1) risk factors and preventative strategies; and (2) surgical strategies to manage this condition. Risk factors were classified as either unmodifiable or modifiable. Attempts to decrease the risk of PJI should target the latter group. Strategies to prevent PJI include the use of silver-coated implants, timely discontinuation of perioperative antibiotic prophylaxis, and adequate soft tissue coverage to diminish the amount of dead space. Regarding surgical treatment, main strategies include debridement, antibiotics, implant retention (DAIR), DAIR with modular component exchange, stem retention (DAIR plus), one-stage, and two-stage revision. Two-stage revision is the “gold standard” for PJI in conventional implants; however, its success hinges on adequate soft tissue coverage and willingness of patients to tolerate a spacer for a minimum of 6 weeks. DAIR plus and one-stage revisions may be appropriate for a select group of patients who cannot endure the morbidity of two surgeries. Moreover, whenever DAIR is considered, exchange of the modular components should be performed (DAIR plus). Due to the low volume of megaprostheses implanted, studies assessing PJI should be conducted in a multi-institutional fashion. This would allow for more meaningful comparison of groups, with sufficient statistical power. Level of evidence: IV.

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Section: Risk Of Pji In Megaprosthesismentioning

confidence: 99%

Risk Factors and Management of Prosthetic Joint Infections in Megaprostheses—A Review of the Literature

Gonzalez,

Pretell-Mazzini,

Lozano-Calderon

2023

Antibiotics

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“…The "Test" laminar flow surgical theater built with the aid of SNL was an outstanding success, and was in use for decades in Albuquerque. The use of laminar clean room based surgical facilities dramatically improved the morbidity rate as well as the incidence of post surgical complications (Coriell et al, 1968;Franco et al, 1977;Nelson, 1978).…”

Section: The Sandia National Laboratories (Snl) Solutionmentioning

confidence: 99%