CONTAMINATION DURING TOTAL JOINT REPLACEMENT SURGERY- A FIVE YEARS FOLOW UP

Abstract

Purpose: To study the frequency and the type of pathogen contaminating the surgical wound during total joint replacement in a standard operating theatre

Type of Study: A prospective study.

Material and Methods: 100 patients, mean age 67 years, 56 females and 44 males, were available for 5 years follow-up after total joint replacement, of the 100 patients 13 underwent total hip replacement and 87 total knee replacement for osteoarthritis, 1 gram of cefazolin was given with induction of anesthesia and a further three doses of 1 gram i.v. cefazolin were given every 8 hours after surgery. The following swab cultures were taking from: skin knife, deep soft tissue knife, joint prosthesis after implantation, orthopaedic lavage fluid, suction tip, lamp hundle, operator gown, deep facia suture, skin (after removal of steridrape), surgical gloves, ambient air. Altogether 1100 cultures were taken. At five years 20 patients were lost to follow up. Ptients of the contaminated groupe were all available for follow up.

Results: 8 patients ( 8%) had one or more positive culture. Non was from ambient air, suction tip, orthopaedic lavage fluid and gloves. Four skin knife had positive cultures ( all with Staph. Coag. Negative ), and 4 deep soft tissue knife cultures ( 2 Staph. Coag. Neg., 1 Staph. Coag. Positive and one Klepsiella). Two facial sutures cultures were positive ( both alfa hemolytic strep.) One lamp hundle positive culture ( Staph. Coag. Neg. ). One joint prosthesis positive culture ( Staph. Coag. Neg. ). One gown positive culture ( Alpha. Hemolytic Strept. ). One skin positive culture (Staph. Coag. Neg.). No clinical signs of infection were seen in any case in the first year. During the second and the third year two patients showed increasing pains due to septic loosening with Staph. Coag. Neg. ( the same contaminating microorganism).

Conclusions: Microbial contamination of the wound is common. Cefazolin seems to be an effective prophylactic, but despite the antibiotic treatment 20% of the contaminated patients developed late low grade infection, loosening of the prosthesis and needed revision surgery, therefore cultures should be taken during joint replacement surgery and antibiotic treatment should be continued in case of positive culture.