Bacterial contamination of the wound during primary total hip and knee replacement

Figures & data

Table 1. Contaminating organisms and number of contaminated sites

Organism	THR		TKR
	1 site	2 sites	1 site	2 sites	3 sites
Coagulase-negative staphylococcus (CNS)	10 ^a	3	11	4
Staphylococcus aureus	3		4 ^b	1	1
Staphylococcus species				1
Corynebacterium species	1
Viridans group streptococcus	1
Bacillus species	1

^a 1 of these patients was positive for both CNS and Bacillus species from the same sample from the splash basin.

^b 1 of these patients had growth of both Staphylococcus aureus and Enterococcus from the same sample from the intercondylar notch.

Table 2. Sites of contamination and duration of surgery at sample collection

Site	No. of samples taken	THR Median minutes of surgery at sample acquisition (range)	No. of positive samples	No. of samples taken	TKR Median minutes of surgery at sample acquisition (range)	No. of positive samples
Before cementing	45	40 (20–133)	2	39	50 (30–123)	8
After cementing	47	68 (40–173)	4	41	75 (45–140)	3
Splash basin	46	87 (55–193)	9	41	80 (50–118)	12
Fascia	46	86 (55–204)	7	41	85 (63–153)	7

Table 3. Demographic and perioperative variables

Variable	THR, n = 49	TKR, n = 41	Uncontaminated THRs and TKRs, n = 49	Contaminated THRs and TKRs, n = 41	p-value
Sex, F/M	28/21	22/19	29/20	21/20	0.6 ^b
Median age (range)	69 (46–89)	69 (49–84)	69 (46–89)	69 (49–86)	0.9 ^c
No. with ASA grade
1	3	2	4	1	0.4 ^d
2	42	30	40	32
3	3	9	5	7
4	1	0	0	1
Median BMI (range) ^a	26 (19–41)	28 (18–40)	27 (18–41)	27 (22–39)	1 ^c
Perioperative antibiotics, n
Cloxacillin	40	32	38	34	0.02 ^d
Clindamycin	6	4	9	1
Cefazolin	3	5	2	6
Median duration of surgery (range), min	97 (58–218)	100 (68–165)	94 (58–181)	102 (65–218)	0.1 ^c

^a THRs: 16 missing values; TKRs: 7 missing values.

^b Chi-square test.

^c Wilcoxon rank-sum test.

^d Fisher’s exact test.

Figure 1. Outcome in the THR group.

Figure 2. Outcome in the TKR group.

Table 4. Previous studies on intraoperative contamination and PJI that reported the number of operations with contamination and that had follow-up

Authors and year	Patients n	Contaminated		Duration of follow-up, years	Deep infections n
		n	%
Davis et al. 1999	100	63	63	2	1
Knobben et al. 2006	100	36	36	2	6
Byrne et al. 2007	80	18	22.5	4.1	0

Davis N, Curry A, Gambhir AK, Panigrahi H, Walker CR, Wilkins EG, et al. Intraoperative bacterial contamination in operations for joint replacement. J Bone Joint Surg (Br) 1999; 81 (5): 886-9.

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Knobben BA, Engelsma Y, Neut D, van der Mei HC, Busscher HJ, van Horn JR. Intraoperative contamination influences wound discharge and periprosthetic infection. Clin Orthop 2006; (452): 236-41.

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Byrne AM, Morris S, McCarthy T, Quinlan W, O’Byrne JM. Outcome following deep wound contamination in cemented arthroplasty. Int Orthop 2007; 31 (1): 27-31.

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