Prevention of Infection in Orthopaedic Joint Replacement (Clinical FEATURE‪)‬

In his original series of THRs in 1964, Charnley reported post operative surgical site infection rates of 9.5% (Charnley 1964). Implementation of measures to reduce infection risk including: ventilation systems, theatre clothing, antibiotic prophylaxis and surgical technique, have significantly reduced infection rates. A combination of clean air, occlusive clothing and antibiotic prophylaxis reduced the deep infection rate after THR and total knee replacement (TKR) from 3.4% to 0.06% (Lidwell et al 1982). A 2005 UK study found a 3.1% incidence of surgical site infection following THR, with each event resulting in a mean increase in length of stay of 11.5 days and an increased cost of -3,542 (Coello et al 2005). A foreign body within a joint increases the risk of infection. While 10,000 organisms are needed to infect a normal marrow cavity in an experimental model, only 50 are needed to cause an infection of a cemented THR (Southwood et al 1985). Even in a laminar flow ultraclean air theatre 29% of gloves, 14.5% of light handles, and 18% of gowns are contaminated by the end of the procedure (Hamilton&Jamieson 2008).