Summary: Using contemporary data from the NZJR and SSIIP, the use of surgical helmet systems reduced the rate of PJI following primary TKA when compared to conventional surgical gowning.

Background

Early data from arthroplasty registries reported the use of a surgical helmet system (or space suit) as a risk factor for deep infection following primary total knee arthroplasty (TKA). However, national registries may underestimate the true rate of deep infection. In New Zealand, the Surgical Site Infection Improvement Programme (SSIIP) was implemented to record any prosthetic joint infection (PJI) occurring within 90 days of an arthroplasty procedure.

Hypothesis/Purpose:
This study aimed to identify the patient and surgical risk factors, including the use of surgical helmet systems, for PJI by analyzing modern data on primary TKA procedures recorded by both the New Zealand Joint Registry (NZJR) and the SSIIP.

Methods

Primary TKA procedures performed between 2013 and 2018 that were recorded by both the NZJR and SSIIP were analyzed. Two primary outcomes were measured: 1) PJI occurring with 90 days as recorded by the SSIIP and 2) Revision TKA for deep infection occurring within 6 months as recorded by the NZJR. Univariate and multivariate adjusted analyses were performed to identify risk factors for both outcomes.

Results

A total of 19,322 primary TKA were recorded by both databases in which 97 patients had a PJI within 90 days as recorded by the SSIIP (0.50%) and 90 patients had a revision TKA for deep infection within 6 months (0.47%) as recorded by the NZJR. The use of surgical helmet systems was associated with a lower rate of PJI (adjusted OR = 0.50, p = 0.008) and revision for deep infection (adjusted OR = 0.55, p = 0.022) when compared to conventional gowning. Male sex and an ASA score of greater than 2 were patient risk factors for infection.

Conclusion

Using contemporary data from the NZJR and SSIIP, the use of surgical helmet systems reduced the rate of PJI following primary TKA when compared to conventional surgical gowning. Male sex and higher ASA score continue to be risk factors for infection.

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Risk Factors For Prosthetic Joint Infection Following Total Knee Arthroplasty: Combined Results From The New Zealand Joint Registry And Surgical Site Infection Improvement Programme

Risk Factors For Prosthetic Joint Infection Following Total Knee Arthroplasty: Combined Results From The New Zealand Joint Registry And Surgical Site Infection Improvement Programme

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Risk Factors For Prosthetic Joint Infection Following Total Knee Arthroplasty: Combined Results From The New Zealand Joint Registry And Surgical Site Infection Improvement Programme

Risk Factors For Prosthetic Joint Infection Following Total Knee Arthroplasty: Combined Results From The New Zealand Joint Registry And Surgical Site Infection Improvement Programme

Background

Methods

Results

Conclusion