title: Risk of Contamination in Assembled vs Disassembled Instruments in Hip Arthroplasty Surgery.
abstract: Periprosthetic joint infection (PJI) is one of the most common causes of revision total hip arthroplasty (THA) and associated with higher costs, prolonged pain, and worse clinical outcomes. Many factors have been linked to increased infection rates, one being the operative equipment and instrumentation used during the surgical procedure. With few arthroplasty instruments designed for complete disassembly and increasingly complex instrument designs, this study seeks to understand the effect that instrument disassembly plays on infection using disassembled and assembled standard femoral broach handles (BHs).
  
  
  
  Two BHs, not designed for disassembly, were modified and then contaminated in the disassembled state with Geobacillus stearothermophilus vegetative-form bacteria and spores. Using both flash and standard sterilization cycles, the BHs were steam sterilized in the disassembled or assembled state and then analyzed for remaining bacteria and spores.
  
  
  
  At all target locations after either a flash sterilization cycle or a standard sterilization cycle, complete eradication of both the vegetative-form and spore-form of G stearothermophilus was achieved.
  
  
  
  This study demonstrates that adequate decontamination of the tested BHs can be achieved after steam sterilization in either the disassembled or assembled state, without an increased risk of infection transmission.
authors.affiliation: Department of Orthopaedic Surgery, University of California, Irvine, Orange, California.
authors.forename: Ryan R
authors.initials: RR
authors.lastname: Mayer
authors.affiliation: Scoliosis and Spine Tumor Center, Texas Back Institute, Plano, Texas.
authors.forename: S Samuel
authors.initials: SS
authors.lastname: Bederman
authors.affiliation: Department of Orthopaedic Surgery, University of California, Irvine, Orange, California.
authors.forename: Vincent M
authors.initials: VM
authors.lastname: Colin
authors.affiliation: Department of Infectious Diseases, University of California, Irvine, Orange, California.
authors.forename: Martina M
authors.initials: MM
authors.lastname: Berger
authors.affiliation: Department of Infectious Diseases, University of California, Irvine, Orange, California.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Cesario
authors.affiliation: Division of Adult Reconstruction, Department of Orthopaedic Surgery, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York.
authors.forename: Ran
authors.initials: R
authors.lastname: Schwarzkopf
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D004866:Equipment Contamination / Q000706:statistics & numerical data*; D001411:Geobacillus stearothermophilus; D006801:Humans; D012306:Risk; D013242:Sterilization / Q000379:methods*; D013525:Surgical Instruments
keywords: contamination; disassembled; instrumentation; periprosthetic joint infection; sterility; total hip arthroplasty