Joint prosthetic infections: a success story or a continuous concern?

In this issue of Acta Orthopaedica, there are 2 papers dealing with postoperative infections after joint arthroplasty. Stefansdóttir et al. (2009) discuss the timing of the preoperative prophylactic antibiotics and Dale et al. (2009) report a possible increase in the infection rate for total hip arthroplasty in Norway. These papers give us reason to reflect on the question of whether our efforts to prevent surgical site infections are sufficiently effective, and what percentage of infection we should try to achieve as a result of all our preventive measures.

A deep postoperative infection in orthopedic surgery involves bone and biomaterials, and is difficult to heal without removal of the biomaterials. Although the infection rate of 1–2% in clean orthopedic operations is low compared to other kinds of surgery, there is a constant need to maintain the best possible infection prevention. Now and then, there is an episode of outbreak of surgical site infections (SSIs), sometimes with infection rates of more than 4–5%. The causes of such disastrous periods mostly remain unclear, but often the result is that the preventive measures are tightened by the orthopedic surgeons, which often causes irritation and resistance from other workers in the hospital.