Antibiotic Prophylaxis and the Risk of Surgical Site Infections following Total Hip Arthroplasty: Timely Administration Is the Most Important Factor

The risk of periprosthetic joint infection from hematogenous bacterial seeding is increased in patients undergoing dental procedures that facilitate the development of bacteremia. We herein report the case of a patient without a history of dental procedures who suffered from an acute metastatic infection of a hip prosthesis by the oral bacterium Streptococcus mutans 18 months after undergoing revision total hip arthroplasty. The patient was successfully treated by two-stage revision surgery. It is important to realize that the efficacy of antibiotic prophylaxis against joint infections has not yet been convincingly proven. As a result, optimal dental hygiene and regular dental visits may be more important than antibiotic prophylaxis for maintaining joint health. Therefore, orthopedic surgeons should educate patients with joint prostheses about good oral health.

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DOES TOPICAL USE OF GENTAMICIN REDUCE THE INFECTION RATE IN PRIMARY TOTAL HIP ARTHROPLASTY?

Acta Ortopédica Brasileira ◽

10.1590/1413-785220192704219177 ◽

2019 ◽

Vol 27 (4) ◽

pp. 197-201 ◽

Cited By ~ 1

Author(s):

Caio Luiz de Toledo Oliveira ◽

Felipe Abrahão Elias ◽

André dos Santos Ribacionka ◽

Celso Hermínio Ferraz Picado ◽

Flávio Luís Garcia

Keyword(s):

Total Hip Arthroplasty ◽

Antibiotic Prophylaxis ◽

Hip Arthroplasty ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

University Hospital ◽

Fisher Exact Test ◽

Infection Rates ◽

Total Hip ◽

Primary Total Hip Arthroplasty

ABSTRACT Objective: To determine whether the topical use of gentamicin reduces periprosthetic joint infection rates in primary total hip arthroplasty (THA). Methods: We retrospectively evaluated two cohorts of patients who underwent primary THA in a university hospital, with a minimum of 1-year postoperative follow-up and full clinical, laboratory, and radiological documentation. Patients who underwent operation in the first 59 months of the study period (263 hips) received only intravenous cefazolin as antibiotic prophylaxis (Cef group), and those who underwent operation in the following 43 months (170 hips) received intravenous cefazolin plus topical gentamicin directly applied on the wound as antibiotic prophylaxis (Cef + Gen group). For the diagnosis of periprosthetic joint infection, we used the criteria of the Centers for Disease Control and Prevention. Data were analyzed using the Fisher exact test, and p values of <0.05 were considered significant. Results: Thirteen hips (4.9%) in the Cef group and eight hips (4.7%) in the Cef + Gen group presented periprosthetic joint infection. Statistical analysis revealed no difference between the infection rates (p = 1.0). Conclusion: Topical gentamicin as used in this study did not reduce periprosthetic joint infection rates in primary THA. Level of Evidence III, Retrospective comparative study.

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Reporting Surgical Site Infections Following Primary and Revision Hip Arthroplasty— One Size Does Not Fit All

Infection Control and Hospital Epidemiology ◽

10.1086/658912 ◽

2011 ◽

Vol 32 (3) ◽

pp. 296-297 ◽

Cited By ~ 4

Author(s):

LJ Worth ◽

AL Bull ◽

MJ Richards

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Risk Index ◽

Surgical Site Infections ◽

Revision Hip Arthroplasty ◽

Total Hip ◽

Clinical Phenomenon ◽

Using Data ◽

Healthcare Associated ◽

Current Risk

The risk of surgical site infection (SSI) is greater after revision hip arthroplasty than after primary procedures. While this is accepted as a clinical phenomenon, standardized surveillance strategies for healthcare-associated infections, including SSIs, do not currently take this into consideration. Most notably, the National Nosocomial Infections Surveillance (NNIS) risk index for stratification does not differentiate between primary and revision surgeries. Using data from a single US center, Leekha et al. recently demonstrated that the risk for SSI was almost twice as high after revision total hip arthroplasty when compared to primary total hip arthroplasty and that risk was even greater when deep incisional or organ/space infections were analyzed. The objective of this study was to compare SSI rates following primary and revision hip arthroplasty in a much larger Australian population to determine whether differences are accounted for by current risk indexing.

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Incidence, Causes, and Timing of 30-Day Readmission following Total Hip Arthroplasty

The Journal of Hip Surgery ◽

10.1055/s-0039-1687849 ◽

2019 ◽

Vol 03 (03) ◽

pp. 118-123

Author(s):

Gannon L. Curtis ◽

Michael Jawad ◽

Linsen T. Samuel ◽

Carlos A. Higuera-Rueda ◽

Bryan E. Little ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Linear Regression Analysis ◽

Surgical Site Infections ◽

Cardiovascular Complications ◽

Wound Complications ◽

Improvement Program ◽

Gastrointestinal Complications ◽

Total Hip ◽

Common Causes

AbstractUnplanned readmissions are associated with increased financial burdens. It is important to understand why they occur and how to reduce them. This study identifies incidences, trends, causes, and timing of 30-day readmissions after total hip arthroplasty (THA). Primary THA cases from 2012 to 2016 in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database were identified (n = 122,451). Fractures (n = 3,990), nonelective surgery (n = 1,715), and bilateral THA (n = 730) were excluded, leaving 116,016 cases. Linear regression analysis determined readmission trends overtime. The readmission rate after THA from 2012 to 16 was 3.32%, which significantly decreased during this time (p = 0.022). The top five causes of readmission included musculoskeletal complications (14.8%), deep surgical site infections (SSI; 11.1%), non-SSI infections (10.8%), gastrointestinal complications (GI; 7.5%), and cardiovascular complications (CV; 7.0%). The most common cause of readmission during week 1 was non-SSI infections (13.0%), week 2 was musculoskeletal complications (16%), week 3 was deep SSI (18.4%), and week 4 was deep SSI (18.6%). Causes of readmission that significantly decreased (p < 0.05) from week 1 to 4 include CV complications, GI complications, non-SSI infections, pain, and respiratory complications. In contrast, causes that significantly increased during this time included deep SSI, prosthesis complications, superficial SSI, and wound complications. Readmissions following THA significantly declined from 2012 to 2016. The most common causes of readmission were musculoskeletal complications, deep SSI, non-SSI infections, GI complications, and CV complications. Interestingly, the most common causes of readmission changed from week to week. These findings may help to develop policies to prevent readmissions following THA.

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