Morbidly obese, diabetic, younger, and unilateral joint arthroplasty patients have elevated total joint arthroplasty infection rates.

The study aims to delineate the deep infection rates and infection risk factors for primary total knee and total hip arthroplasty patients. A retrospective review was conducted on 6108 patients from 1991 to 2004. The deep infection cases were compared to the noninfected cohort whereby infection risk factors were identified. Of the 8494 joint arthroplasties, 43 (0.51%) developed a deep infection (30 total knee arthroplasties, 13 total hip arthroplasties). Patients with a body mass index greater than 50 had an increased odds ratio of infection of 21.3 (P < .0001). Diabetic patients were 3 times as likely to become infected compared to nondiabetic patients (P = .0027). Simultaneous bilateral total joint arthroplasties were found to have developed infection 3 times less frequently than those performed as unilateral procedures (P = .0024). The average age in our infection cohort was 64.3 and 68.4 in the noninfected cohort. In this retrospective review study, obesity, diabetes, and younger age were found to be risk factors for joint arthroplasty infection.

Ultraviolet lighting during orthopaedic surgery and the rate of infection.

BACKGROUND: Ultraviolet lighting is an alternative to laminar airflow in the operating room that may be as effective for lowering the number of environmental bacteria and possibly lowering infection rates by killing the bacteria rather than simply reducing the number at the operative site. The purpose of the present study was to compare the infection rates following joint replacement procedures performed by one orthopaedic surgeon with and without the use of ultraviolet lighting. METHODS: From July 1986 to July 2005, one surgeon performed 5980 total joint replacements at one facility. In September 1991, ultraviolet lighting was installed in the operating rooms. All procedures that were performed before the installation of the ultraviolet lighting utilized horizontal laminar airflow, whereas all procedures that were performed after that date utilized ultraviolet lighting without laminar airflow. Factors associated with the rate of infection were analyzed. RESULTS: Over a nineteen-year period, forty-seven infections occurred following 5980 joint replacements. The infection rate without ultraviolet lighting (and with laminar airflow) was 1.77%, and the infection rate with ultraviolet lighting was 0.57% (p < 0.0001). The odds of infection were 3.1 times greater for procedures performed without ultraviolet lighting (and with laminar airflow) as compared with those performed with only ultraviolet lighting (p < 0.0001). The infection rate associated with total hip replacement decreased from 1.03% to 0.72% (p = 0.5407), and the infection rate associated with total knee replacement decreased from 2.20% to 0.50% (p < 0.0001). Revision surgery, previous infection, age, total body mass index, use of cement, disease, and diagnosis were not associated with an elevated infection rate. CONCLUSION: When appropriate safety precautions are taken, ultraviolet lighting appears to be an effective way to lower the risk of infection in the operating room during total joint replacement surgery.