Infection prevention methodologies for lower extremity total joint arthroplasty

Abstract

Despite advances in our understanding of surgical site infections following total joint arthroplasty, this serious surgical complication continues to represent a substantial economic burden for the patient, the treating institution and the healthcare system. After increasing for the past decade, infection rates have stabilized at 1.6%; however, the total cost is projected to increase with the total number of revision procedures performed. A systematic review of the literature was performed to identify studies that assess the efficacy of pre-, peri- and post-operative infection prevention strategies in the setting of total hip or knee arthroplasty. Preference was given to randomized-controlled trials, data from national registries and meta-analyses within the past 5 years; however, all relevant articles were included in this analysis. The results of the literature search returned 549 articles that addressed infection in total joint arthroplasty, of which 71 specifically addressed infection prevention. Topics that were addressed included the CDC recommendations, skin preparation techniques, hair removal techniques, surgical draping techniques, operative dress, operating room ventilation, operating room traffic and antibiotic utilization. Newer infection prevention techniques, such as preoperative antiseptic scrubbing, are affected and may help reduce the infection rate, while traditionally accepted methods of prophylaxis such as laminar-flow operating rooms and body exhaust suits may raise the infection rate.

Keywords::

• prevention methodologies
• surgical site infection
• total joint arthroplasty

Financial & competing interests disclosure

BH Kapadia is presently a consultant and on a speakers bureau for Sage Products, Inc. AJ Johnson has served on the speakers bureau for Sage Products, Inc. and is a paid consultant for Sage Products, Inc. and OCSI. JA Daley has served on the speakers bureau for 3M and Sage Products, Inc. and owns stock in Pfizer, GE Healthcare and 3M. MA Mont is a legal consultant for DePuy, has received royalties from Stryker and Wright Medical Technology, Inc., has served on speakers bureau for Sage Products, Inc., has acted as a paid consultant for DJ Orthopaedics, Janssen, Joint Active Systems, Medtronic, Sage Products, Inc., Stryker, TissueGene and Wright Medical Technology, Inc. and has received research support from DJ Orthopaedics, Joint Active Systems, NIH (NIAMS & NICHD), Sage Products, Inc., Stryker, Tissue Gene and Wright Medical Technology, Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.