Intraoperative Contamination Influences Wound Discharge and Periprosthetic Infection

Abstract

Intraoperative bacterial contamination increases risk for postoperative wound-healing problems and periprosthetic infection, but to what extent remains unclear. We asked whether bacterial contamination of the instruments and bone during primary prosthesis insertion was associated with prolonged wound discharge and subsequent periprosthetic infection. During 100 total hip arthroplasties, four intraoperative cultures were taken from the instruments and two portions of removed bone. Postoperatively, the duration of wound discharge was monitored, with Day 5 as the cut-off point. All patients were followed for 2 years to determine whether periprosthetic infection occurred. Bacterial contamination occurred in 36 operative procedures (36%). We found an association between intraoperative contamination and prolonged wound discharge, with a relative risk of 2.5. The culturing of removed bone had a positive predictive value of 81% to 90%. Other factors associated with prolonged wound discharge were rheumatoid arthritis (relative risk, 6.4), use of cement (relative risk, 1.6), and increased blood loss (relative risk, 1.5).

Blood Culture Flasks for Culturing Synovial Fluid in Prosthetic Joint Infections

“…The contamination of samples obtained during surgery is frequent [7,9,12], and some authors have proposed a protocol based on multiple samples to rule out contaminants [1]. No synovial fluid culture and only one swab culture was positive in our patients who fulfilled the criteria of aseptic loosening.…”

The Gown-glove Interface Is a Source of Contamination: A Comparative Study

“…However, other studies have associated intraoperative contamination with subsequent deep infection. Knobben took four intraoperative cultures from instruments and two portions of removed bone during 100 THAs [9]. Bacterial contamination was identified in 36% of procedures, and six of 36 (17%) patients with intraoperative contamination developed deep infection compared with one of 64 (1.5%) patients without contamination (p = 0.008).…”

Procrastination of Wound Drainage and Malnutrition Affect the Outcome of Joint Arthroplasty

“…Therefore, some studies have advocated surgical intervention for cases of persistent surgical site drainage [2,11,12]. The risk factors associated with prolonged surgical site discharge including morbid obesity, advanced age, rheumatoid arthritis, the use of low-molecular-weight heparin, and increased blood loss or drain output have been thoroughly investigated [6,9,14]. However, the literature contains little about which, if any, factors predict the likelihood of spontaneous cessation of drainage versus the need for surgical intervention.…”