Postarthroscopy Surgical Site Infections: Review of the Literature

Abstract

The use of arthroscopy for both diagnosis and operative intervention has been increasing steadily since its introduction in the 1970s. It is generally associated with fewer complications and shorter times to mobilization than are open procedures. Overall reported rates of complications are low (0.1%-0.6% of procedures). This review focuses on infectious complications of arthroscopy, which are rare (0.01%-0.48% of procedures) but result in significant morbidity for the patient when they occur. The most commonly reported causative organisms are staphylococci. Several outbreaks have been reported related to breaks in infection control or to contaminated instruments. Suggested risk factors include use of intra-articular corticosteroids, prolonged tourniquet time, patient's age >50 years, failure to prepare the surgical site again before conversion to arthrotomy, procedure complexity, and a history of previous procedures. However, most reports use variable and unclear definitions of infection, which makes it difficult to draw firm conclusions.

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

“…Direct implantation, either through trauma or an iatrogenic event (e.g., following an intra-articular steroid injection), accounts for most of the remainder. Rarely, septic arthritis can occur following arthroscopy, the reported incidence of which is 0.01 to 0.23% (462).…”

The effect of sterile versus non-sterile tourniquets on microbiological colonisation in lower limb surgery

“…10,11 Such infections develop in 1-3% of knee surgical procedures 10 and are associated with poor outcome and increased cost. 8 Although the colony counts were low, it is certainly possible that bacteria will move from the tourniquet to the surgical field during surgery or when dressing the wound.…”

Difficulty in Diagnosing Surgical Site Infection After Arthroscopy in Developing Countries

“…1 Although infectious complications after arthroscopy appear to be fairly rare (0.01%-0.48% of procedures), significant morbidity and significant costs are associated with the procedure. 2 In Thailand, although arthroscopy has been increasingly performed during the past decade, it has not been incorporated into the surveillance systems of most Thai hospitals, 3 and postdischarge surveillance is often suboptimal. 4 The lack of a national benchmark also makes it difficult to compare rates of surgical site infection (SSI) after arthroscopy between hospitals.…”

“…Because of the low incidence of SSI after arthroscopy, 1,2 studies that try to delineate the risk factors for SSI and/or that try to describe the effects of the implementation of preventive measures during orthopedic surgery are challenging. Suboptimal hand washing between procedures, lapses in sterile technique, and high traffic during procedure Suboptimal hand washing between procedures, lapses in sterile technique, high traffic during procedure Suboptimal hand washing between procedures, high traffic during procedure High traffic during procedure High traffic during procedure High traffic during procedure N O T E .…”