The outcome of perioperative wound infection after total hip and knee arthroplasty

Abstract

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.

Infection Associated With Hematoma Formation After Shoulder Arthroplasty

“…Postoperative hematoma formation is a well-known complication after hip and knee arthroplasty [1,2,8,9] and in one study was associated with superficial and deep infection [8]. Large hematomas that cause persistent drainage are rare after total joint arthroplasty but may require a return to the operating room for evacuation, irrigation, débridement, and wound closure.…”

Single-use instrumentation in posterior lumbar fusion could decrease incidence of surgical site infection: a prospective bi-centric study

“…The results of the prospective bi-centric study suggest that the single-use instrumentation could reduce the incidence of surgical site infections following posterior lumbar fusion to the acceptable levels established for hip (1-2 %) and knee (2-4 %) arthroplasty [43,44]. The preservation of screws and rods in their sterile packs until they are ready to be inserted reduces their exposure to air-borne bacteria in the operating room and eliminates their contamination through repetitive hospital cleaning and sterilization procedures.…”

Increased Antibiotic Release from a Bone Cement Containing Bacterial Cellulose

“…Therefore, to avoid mechanical weakening of such cements, low doses of incorporated antibiotics (less than 2 g per 40 g of PMMA powder) have been recommended [6,13,22]. However, despite these efforts, the annual incidence of periprosthetic infections remains at 1% to 4% [1,10]. Therefore, development of bone cements that can be loaded with high levels of antibiotics while retaining mechanical strength is desirable.…”