A new study led by Robert S. Namba, MD, of the department of orthopedic surgery at Kaiser Permanente Orange County and Southern California Permanente Medical Group in Irvine, and published in the Journal of Bone & Joint Surgery, assesses risk factors for deep surgical site infections after total knee arthroplasty. The study followed 56,216 primary total knee arthroplasties recorded in a total joint replacement registry from 2001 to 2009, in which 63 percent were performed in female patients. Incidence of deep surgical site infection was 0.72 percent, and a fully adjusted model showed patient risk factors including:
• BMI of 35 or higher;
• Diabetes mellitus;
• Male sex;
• American Society of Anesthesiology score of three or greater;
• Osteonecrosis;
• Posttraumatic arthritis.
Protective surgical factors included:
• Use of antibiotic irrigation;
• Bilateral procedures;
• Lower hospital volume.
Surgical risk factors were:
• Quadriceps-release exposure;
• Antibiotic-laden cement use;
• Operative time increased risk by 9 percent per 15 minute increment.
Study authors recommended using comprehensive infection surveillance systems and a total joint replacement registry to further identify factors associated with infection risk for total knee arthroplasty patients.
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