title: The impact of patient and surgical factors on the rate of infection after primary total knee arthroplasty: an analysis of 64,566 joints from the New Zealand Joint Registry.
abstract: OBJECTIVE
  The aim of this study was to identify risk factors for prosthetic joint infection (PJI) following total knee arthroplasty (TKA).
  
  
  METHODS
  The New Zealand Joint Registry database was analysed, using revision surgery for PJI at six and 12 months after surgery as primary outcome measures. Statistical associations between revision for infection, with common and definable surgical and patient factors were tested.
  
  
  RESULTS
  A total of 64 566 primary TKAs have been recorded on the registry between 1999 and 2012 with minimum follow-up of 12 months. Multivariate analysis showed statistically significant associations with revision for PJI between male gender (odds ratio (OR) 1.85, 95% confidence interval (CI) 1.24 to 2.74), previous surgery (osteotomy (OR 2.45 95% CI 1.2 to 5.03), ligament reconstruction (OR 1.85, 95% CI 0.68 to 5.00)), the use of laminar flow (OR 1.6, 95% CI 1.04 to 2.47) and the use of antibiotic-laden cement (OR 1.93, 95% CI 1.19 to 3.13). There was a trend towards significance (p = 0.052) with the use of surgical helmet systems at six months (OR 1.53, 95% CI 1.00 to 2.34).
  
  
  CONCLUSIONS
  These findings show that patient factors remain the most important in terms of predicting early PJI following TKA. Furthermore, we found no evidence that modern surgical helmet systems reduce the risk of PJI and laminar flow systems may actually increase risk in TKA. The use of this registry data assists the estimation of the risk of PJI for individual patients, which is important for both informed consent and the interpretation of infection rates at different institutions.
  
  
  CONCLUSIONS
  Infection rates in TKA are related to both individual patient and surgical factors, and some modern methods of reducing infection may actually increase infection risk.
authors.affiliation: North Shore Hospital, Private Bag 93-503, Takapuna, Auckland 0740, New Zealand.
authors.forename: E R
authors.initials: ER
authors.lastname: Tayton
authors.affiliation: University of Otago, PO Box 4345, Christchurch, New Zealand.
authors.forename: C
authors.initials: C
authors.lastname: Frampton
authors.affiliation: Dept of Orthopaedic Surgery & Musculoskeletal Medicine, Univ of Otago, Christchurch, PO Box 4345, Christchurch, New Zealand.
authors.forename: G J
authors.initials: GJ
authors.lastname: Hooper
authors.affiliation: Department of Orthopaedics, North Shore Hospital, Private Bag 93-503, Takapuna, Auckland, 0740, New Zealand.
authors.forename: S W
authors.initials: SW
authors.lastname: Young
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D012042:Registries; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Arthroplasty; Infection; Obesity.; Risk Factors; TKA; Total Knee Replacement