title: Incidence and risk factors for surgical infection after total knee replacement.
abstract: Surgical site infection (SSI) after total knee replacement (TKR) is a devastating complication. We performed a retrospective study of all consecutive TKRs performed during a 2-y period. Surgical site infection (SSI) was defined by standard criteria. All patients were examined 1 y following surgery. Of 180 patients undergoing TKR, 10 (5.6%) developed a superficial (3, 1.7%) or deep (7, 3.9%) SSI. Two independent risk factors for SSI were detected: left knees became infected more often (9/ 92, 9.8%) than right knees (1/88, 1.1%) (Relative Risk 6.7 +/- 95% CI 1.7-26.8); and 7/72 (9.7%) patients receiving a type-1 prosthesis developed infection versus 3/104 (3.1%) receiving a type-2 prosthesis (RR 4.7, 95% CI 1.18-18.4). Investigation of the operating room revealed 3 problems: there was significant traffic through the door on the left of the patient; a nonstandard horizontal-flow air conditioner had been installed above that door; a tool-washing sink was in use on the other side of that door. Infection control guidelines were rehearsed: the sink was removed, the air conditioner was disconnected, and the door was locked. In a prospective survey performed 2 y later only 1/45 patients (2.2%) undergoing TKR developed a superficial SSI (p = 0.5). Correction of independent risk factors for infection following TKR led to a decrease in SSI rate.
authors.affiliation: Infectious Disease Unit, Shaare Zedek Medical Centre, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Babkin
authors.forename: David
authors.initials: D
authors.lastname: Raveh
authors.forename: Moshe
authors.initials: M
authors.lastname: Lifschitz
authors.forename: Menachem
authors.initials: M
authors.lastname: Itzchaki
authors.forename: Yonit
authors.initials: Y
authors.lastname: Wiener-Well
authors.forename: Puah
authors.initials: P
authors.lastname: Kopuit
authors.forename: Ziona
authors.initials: Z
authors.lastname: Jerassy
authors.forename: Amos M
authors.initials: AM
authors.lastname: Yinnon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods; D007720:Knee Prosthesis / Q000145:classification; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000592:standards; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology