Perioperative Contamination in Primary Total Hip Arthroplasty

All surgical procedures have the risk of microbial contamination. However, procedures in which prosthetic materials are involved have a high risk for future infectious problems because of the protection offered by the biofilm mode of growth. Studies of perioperative contamination have been done on involved surgical instruments, but whether these instruments transmit contamination to the prosthesis or future site of the prosthesis is not known. The aim of this study was to detect possible bacterial contamination in total hip arthroplasty through instruments that are used at the direct site of implantation during the primary procedure. Samples of the broaches used for preparing the acetabulum and femur, and samples of the reamed acetabular and femoral bone, were collected during 67 consecutive primary total hip arthroplasties in 67 patients. Broach samples were taken at the start and end of every reaming procedure. Four hundred two samples were taken, of which 26 were found to be positive for microorganisms. In 20 patients, at least one of these positive samples had been in direct contact with the actual prosthesis site, indicating that at least 30% of the involved patients had a possible bacterial contamination when leaving the operating theater.

Level of Evidence: Diagnostic study, Level I-1 (testing of previously developed diagnostic criteria in series of consecutive patients—with universally applied reference gold standard). See the Guidelines for Authors for a complete description of levels of evidence.