What Are the Risk Factors for Infection in Hemiarthroplasties and Total Hip Arthroplasties? Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. Robot‐assisted total hip arthroplasty: Clinical outcomes and complication rate Revision surgery following total shoulder arthroplasty: analysis of 2588 shoulders over three decades (1976 to 2008). What Are the Instability and Infection Rates After Reverse Shoulder Arthroplasty? Antibiotic prophylaxis and the risk of surgical site infections following total hip arthroplasty: timely administration is the most important factor. Single vs Repeat Surgical Skin Preparations for Reducing Surgical Site Infection After Total Joint Arthroplasty: A Prospective, Randomized, Double-Blinded Study. Hospital cost of dislocation after primary total hip arthroplasty. Midterm Survivorship of the Lefèvre Constrained Liner: A Consecutive Multisurgeon Series of 166 Cases. Periprosthetic infections after shoulder hemiarthroplasty. Periprosthetic infections after total shoulder arthroplasty: a 33-year perspective. Revision total hip arthroplasty in patients 80 years or older. Surgical site infections in orthopedic patients: prospective cohort study. Role of Surgical Dressings in Total Joint Arthroplasty: A Randomized Controlled Trial. Influence of preoperative patient education on the risk of dislocation after primary total hip arthroplasty. Risk factors for surgical-site infection following primary total knee arthroplasty. Surgical site infection rate and associated risk factors in elective general surgery at a public sector medical university in Pakistan.
Background Late infection is the second most frequent early complication after total hip arthroplasty ( THA ) and the most frequent after hemiarthroplasty . Known risk factors for infection after THA include posttraumatic osteoarthritis , previous surgery , chronic liver disease , corticoid therapy , and excessive surgical time . However , risk factors for hemiarthroplasty are not clearly established . Questions / purpose sWe therefore determined the preoperative and intraoperative risk factors for late infection ( more than 3 months after surgery ) in patients with hemiarthroplasties and THAs . Methods We retrospectively compared 47 patients with a hip arthroplasty ( 23 hemiarthroplasties , 24 total hip arthroplasties ) and late infection with 200 r and omly-selected patients with primary arthroplasty ( 100 hemiarthroplasties , 100 total hip arthroplasties ) during the same time period of time without any infection during followup . Potential risk factors were identified from medical records . Minimum followup was 12 months ( mean , 27 months ; range , 12–112 months ) for the study group and 18 months ( mean , 84 months ; range , 18–144 months ) for the control group . Results The following factors were more frequent in late infected hemiarthroplasties : female gender ; previous surgery ; obesity ( body mass index greater than 30 kg/m2 ) ; glucocorticoid and immunosuppressant treatments ; prolonged surgical time ; inadequate antibiotic prophylaxis ; prolonged wound drainage ; hematoma ; dislocation ; and cutaneous , urinary , and /or abdominal infections . The following were more frequent in infected total hip arthroplasties : posttraumatic osteoarthritis ; previous surgery ; glucocorticoids ; chronic liver disease ; alcohol and intravenous drug abuse ; prolonged surgical time ; prolonged wound drainage ; dislocation ; subsequent surgery ; and cutaneous , urinary , respiratory and abdominal infections . Diabetes did not appear to be a risk factor . Conclusions Our data suggest there are specific risk factors for infection in hemiarthroplasties . The major risk factors for late infection in hip arthroplasty must be recognized so they can be minimized or controlled if not possible to employ prophylactic measures .Level of Evidence Level III , prognostic study . See Guidelines for Authors for a complete description of levels of evidence BACKGROUND Deep surgical site infection  following total knee arthroplasty is a devastating complication . Patient and surgical risk factors for this complication have not been thoroughly examined . The purpose of this study was to evaluate risk factors associated with deep surgical site infection following total knee arthroplasty in a large U.S. integrated health-care system . METHODS A retrospective review of a prospect ively followed cohort of primary total knee arthroplasties recorded in a total joint replacement registry from 2001 to 2009 was conducted . Records were screened for deep surgical site infection with use of a vali date d algorithm , and the results were adjudicated by chart review . Patient factors , surgical factors , and surgeon and hospital characteristics were identified with use of the total joint replacement registry . Cox regression models were used to assess risk factors associated with deep surgical site infection . RESULTS A total of 56,216 total knee arthroplasties were identified ; 63.0 % were done in women , the average age of the patients was 67.4 years ( st and ard deviation [ SD ] = 9.6 ) , and the average body mass index ( BMI ) was 32 kg/m2 ( SD = 6 ) . The incidence of deep surgical site infection was 0.72 % ( 404/56,216 ) . In a fully adjusted model , patient factors associated with deep surgical site infection included a BMI of ≥35 ( hazard ratio [ HR ] = 1.47 ) , diabetes mellitus ( HR = 1.28 ) , male sex ( HR = 1.89 ) , an American Society of Anesthesiologists ( ASA ) score of ≥3 ( HR = 1.65 ) , a diagnosis of osteonecrosis ( HR = 3.65 ) , and a diagnosis of posttraumatic arthritis ( HR = 3.23 ) . Hispanic race was protective ( HR = 0.69 ) . Protective surgical factors included use of antibiotic irrigation ( HR = 0.67 ) , a bilateral procedure ( HR = 0.51 ) , and a lower annual hospital volume ( HR = 0.33 ) . Surgical risk factors included quadriceps-release exposure ( HR = 4.76 ) and the use of antibiotic-laden cement ( HR = 1.53 ) . In a sub analysis , operative time was a risk factor , with a 9 % increased risk per fifteen-minute increment . CONCLUSIONS Use of a comprehensive infection surveillance system , combined with a total joint replacement registry , identified patient and surgical factors associated with infection following total knee arthroplasty in a large sample . High-risk patients should be counseled , and modifiable clinical conditions should be optimized . Use of antibiotic irrigation should be encouraged , but antibiotic-laden cement may not be useful . LEVEL OF EVIDENCE Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence BACKGROUND The purpose of this study was to report minimum 2-year outcomes and complications for robotic-arm-assisted total hip arthroplasty ( THA )  . METHODS Data were prospect ively collected and retrospectively review ed between June 2011 and April 2014 . Inclusion criteria were primary robotic-arm-assisted THAs treating idiopathic osteoarthritis with ≥ 2-year follow-up .  Demographics , operating time , complications , 2-year outcome scores and satisfaction , and subsequent surgeries were recorded . RESULTS There were 181 cases eligible for inclusion , of which 162 ( 89.5 % ) had minimum 2-year follow-up . At the latest follow-up , the mean visual analogue scale was 0.7 , satisfaction was 9.3 , Harris hip score was 91.1 and forgotten joint score was 83.1 . Six ( 3.7 % ) intraoperative complications and six ( 3.7 % ) postoperative complications were reported . No leg length discrepancies ( LLDs ) or dislocations were reported . CONCLUSIONS Robotic-arm-assisted THA demonstrates favourable short-term outcomes and does not result in a higher complication rate compared to non-robotic THA as reported by the literature Our objective was to examine the rate of revision and its predictive factors in patients undergoing total shoulder arthroplasty ( TSA ) .  We used prospect ively collected data from the Mayo Clinic Total Joint Registry to examine five- , ten- and 20-year revision-free survival following TSA and the predictive factors . We examined patient characteristics ( age , gender , body mass index , comorbidity ) , implant fixation ( cemented versus uncemented ) , American Society of Anesthesiologists class and underlying diagnosis . Univariate and multivariable adjusted hazard rates were calculated using Cox regression analysis . A total of 2207 patients underwent 2588 TSAs . Their mean age was 65.0 years ( 19 to 91 ) and 1163 ( 53 % ) were women ; osteoarthritis was the underlying diagnosis in 1640 shoulders ( 63 % ) . In all , 212 TSAs ( 8.2 % ) were revised during the follow-up period . At five , ten and 20 years , survival rates were 94.2 % ( 95 % confidence interval ( CI ) 93.2 to 95.3 ) , 90.2 % ( 95 % CI 88.7 to 91.7 ) and 81.4 % ( 95 % CI 78.4 to 84.5 ) , respectively . In multivariable analyses men had a higher hazard ratio of revision of 1.72 ( 95 % CI 1.28 to 2.31 ) ( p < 0.01 ) compared with women , and those with rotator cuff disease had a hazard ratio of 4.71 ( 95 % CI 2.09 to 10.59 ) ( p < 0.001 ) compared with patients with rheumatoid arthritis . We concluded that male gender and rotator cuff disease are independent risk factors for revision after TSA . Future studies are needed to underst and the biological rationale for these differences Background A concern regarding  reverse shoulder arthroplasty ( RSA )  is the possibly higher complication rate compared with conventional unconstrained shoulder arthroplasty . Questions / purpose sWe determined ( 1 ) the rate of instability and infection ; ( 2 ) whether diagnosis influenced instability and infection rates ; and ( 3 ) whether these complications affect ASES , Constant , and WOOS scores after RSA . Methods A prospect i ve data base , clinical charts , and radiographs of 284 patients who had undergone primary ( n = 212 patients ) or revision ( n = 72 patients ) RSA  were review ed to identify patients whose postoperative course was complicated by instability or infection . Results The rate of instability was similar in patients with primary ( eleven of 212 [ 5 % ) ] and revision ( six of 72 [ 8 % ] ) reverse arthroplasty . The rate of infection was higher in the revision ( five of 72 [ 7 % ] ) than in the primary ( three of 212 [ 1 % ] ) group . Patients with an irreparable subscapularis tendon had a higher rate of instability ( 14 of 123 [ 12 % ] ) compared with patients with a repairable subscapularis tendon ( one of 161 [ less than 1 % ] ) . The fracture sequelae group had the highest rate of instability ( seven of 25 [ 28 % ] ) among diagnoses within the primary group . The rates of infection were similar between the diagnoses within the primary group . The improvements in the ASES score , the Constant score , and the WOOS score from preoperatively to postoperatively were better in the no instability/infection group as compared with the instability/infection group . Conclusions This information confirms the available literature allowing surgeons to give patients realistic expectations regarding the infection and instability rates after RSA.Level of Evidence Level III , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence BACKGROUND Surgical site infections ( SSIs ) following total hip arthroplasty can lead to prolonged hospitalization , increased morbidity and mortality , and high costs . This article analyzes the effect of various parameters of surgical antibiotic prophylaxis on the risk of SSI following total hip arthroplasty . METHODS Data about SSI and potential prophylaxis- , patient- , and procedure-related risk factors were prospect ively collected for 1922 patients who underwent elective total hip arthroplasty in 11 hospitals that participated in the Dutch intervention project , Surgical Prophylaxis and Surveillance .  Multivariate logistic regression analysis was performed to correct for r and om variation among hospitals . RESULTS SSIs ( superficial and deep ) occurred in 50 patients ( 2.6 % ) . The highest odds ratios for SSI were found in patients who received prophylaxis after incision ( 2.8 , 95 % confidence interval [ CI ] , 0.9 - 8.6 ; P=.07 ) , had an American Society of Anesthesiology score that was > 2 ( 2.8 , 95 % CI , 0.8 - 9.2 ; P=.09 ) , and experienced a duration of surgery that was > 75th percentile ( 2.5 ; 95 % CI , 1.1 - 5.8 ; P=.04 ) . Prolonged prophylaxis after the end of surgery and the use of antibiotic-impregnated cement did not contribute to fewer SSIs in this study . CONCLUSIONS This study suggests that intervention programs in search of amendable factors to prevent SSI should focus on timely administration of antibiotic prophylaxis BACKGROUND Preventing surgical site infection ( SSI )  after total joint arthroplasty ( TJA ) is a high priority and is partly linked to the efficacy of surgical site preparation solutions ( SPSs ) in reducing the number of pathogens on the skin before incision . The aim of this study is to investigate the effectiveness of SRS reapplication after draping to reduce the incidence of SSI after TJA . METHODS Six hundred patients undergoing primary TJA between 2010 and 2011 at a single institution were recruited and r and omly assigned to one of 2 groups . The patients in the intervention group ( n = 300 ) received SPS that included alcohol and povidone-iodine before draping and an additional SPS by iodine povacrylex and isopropyl alcohol before application of the final adhesive drape , whereas the patients in the control group ( n = 300 ) received a single SPS with alcohol and povidone-iodine before draping . R and omization was performed by an opaque envelope , and the rates of SSI and blistering were compared between groups . RESULTS Five seventy-seven patients completed the study and were included in the final analysis . There was a significant reduction in the incidence of superficial SSI for the intervention group ( 1.8 % , 5 of 283 ) compared to the control group ( 6.5 % , 19 of 294 , P = .02 ) . There were 2 ( 0.7 % , 2 of 294 ) deep incisional SSIs in the control group , and 2 ( 0.7 % , 2 of 283 ) organ-space SSIs in the intervention group ( P = 1.00 ) . In addition , skin blistering was lower in the intervention group ( 3.5 % , 10 of 283 ) vs the control group ( 6.5 % , 19 of 294 ) , but this difference also did not reach statistical significance ( P = .13 ) . CONCLUSION Reapplication of an SPS after draping and before the application of iodophor-impregnated incisive draping result ed in a significant reduction in the rate of SSI in patients undergoing elective TJA BACKGROUND The treatment of dislocation following primary total hip arthroplasty usually requires the use of expensive hospital re sources and sometimes requires revision surgery . The hospital costs associated with treating this complication have not been previously analyzed , to our knowledge . The purpose of this study was to assess the financial impact of treating dislocations at our institution . METHODS Between 1997 and 2001 , 3671 patients underwent a total of 4054 consecutive primary total hip arthroplasties at our institution . The patients were prospect ively followed at regular intervals , and their follow-up data were recorded in an institutional total joint registry . Ninety-nine hips ( 2.4 % ) in ninety-nine patients dislocated . The costs to our institution to treat these dislocations were evaluated by determining the cost of each treatment episode required to reestablish hip stability and were expressed as the percent increase in cost compared with that of an uncomplicated primary total hip replacement . RESULTS Of the ninety-nine hips that dislocated , sixty-two ( 63 % ) remained stable after one or more closed reductions and thirty-seven ( 37 % ) ultimately required revision surgery . The hospital cost of each closed reduction episode represented 19 % of the hospital cost of an uncomplicated total hip replacement . When revision surgery was eventually needed , the average hospital costs of one or more closed reductions and the subsequent revisions represented 148 % of the hospital cost of an uncomplicated primary total hip replacement . CONCLUSIONS Dislocation after primary hip replacement continues to be a prevalent and costly complication that diminishes the cost-effectiveness of an otherwise very successful surgical procedure BACKGROUND Constrained liners are used as part of a salvage procedure to provide stability for patients at high risk for dislocation after a total hip arthroplasty . However , no recent studies exist highlighting their effectiveness and /or limitations . METHOD This prospect i ve review included 166 consecutive hip arthroplasties , either primary ( 27 % ) or revision ( 73 % ) , with a unique design of a constrained liner : Lefèvre retentive cup . There were 113 females ( 69 % ) , and the average age at index surgery was 75.9 years ( range , 35 - 94 ) . The mean follow-up was 6.2 years ( range , 0.3 - 11 ) . RESULTS Twenty patients had a reoperation ; 10 for infection ( 4 acute and 6 chronic joint infection ) and 10 for cup failure ( 5 fixation failure , 3 aseptic loosening , and 2 dislocation ) . Ten-year survivals for cup revision were 89 % ( CI , 83 - 94 ) and 92 % ( CI , 89 - 97 ) for all revision and revision for noninfectious reasons , respectively . When solely evaluating for dislocation , the survival at 10 years was 99 % ( CI , 97 - 100 ) . Considering primary and revision cases , 10-year survivals cup revision for aseptic reasons were 92.4 % ( CI , 84 - 100 ) and 92.5 % ( CI , 87 - 98 ) , respectively . CONCLUSIONS The Lefèvre retentive cup demonstrated excellent 10-year 's survivorship . With the rate of aseptic loosening around 2 % and a dislocation rate around 1 % , the cup is as effective as other available devices and is therefore a cost-effective tool to reduce the risk of dislocation in at-risk patients undergoing hip arthroplasty BACKGROUND To examine the rates and predictors of deep periprosthetic infections after  shoulder hemiarthroplasty .  METHODS We used prospect ively collected institutional registry data on all primary shoulder hemiarthroplasty patients from 1976 - 2008 . We estimated survival free of deep periprosthetic infections using Kaplan-Meier survival curves . Using univariate Cox regression analyses , we examined the association of patient-related factors ( age , sex , body mass index ) , comorbidity ( Deyo-Charlson index ) , American Society of Anesthesiologists grade , underlying diagnosis , and implant fixation with the risk of infection . RESULTS A total of 1,349 patients , with a mean age of 63 years ( SD , 16 years ) , 63 % of whom were women , underwent 1,431 primary shoulder hemiarthroplasties .  Mean follow-up was 8 years ( SD , 7 years ) . Fourteen deep periprosthetic infections occurred during the follow-up , confirmed by medical record review . The most common organisms were Staphylococcus aureus , coagulase-negative Staphylococcus , and Propionibacterium acnes , each accounting for 3 cases ( 21 % each ) . The 5- , 10- , and 20-year prosthetic infection-free rates were 98.9 % ( 95 % confidence interval [ CI ] , 98.3%-99.5 % ) , 98.7 % ( 95 % CI , 98.1%-99.4 % ) , and 98.7 % ( 95 % CI , 98.1%-99.4 % ) , respectively . None of the factors evaluated were significantly associated with risk of prosthetic infection after primary shoulder hemiarthroplasty , except that an underlying diagnosis of trauma was associated with a significantly higher hazard ratio of 3.18 ( 95 % CI , 1.06 - 9.56 ) for infection compared with all other diagnoses ( P = .04 ) . A higher body mass index showed a non-statistically significant trend toward an association with higher hazard ( P = .13 ) . CONCLUSION The periprosthetic infection rate after shoulder hemiarthroplasty was low , estimated at 1.3 % at 20-year follow-up . An underlying diagnosis of trauma was associated with a higher risk of periprosthetic infection . These patients should be observed closely for development of infection BACKGROUND To examine the rates and predictors of deep periprosthetic infections after  primary total shoulder arthroplasty ( TSA ) . METHODS We used prospect ively collected data on all primary TSA patients from 1976 - 2008 at Mayo Clinic Medical Center . We estimated survival free of deep periprosthetic infections after primary TSA using Kaplan-Meier survival . Univariate and multivariable Cox regression was used to assess the association of patient-related factors ( age , gender , body mass index ) , comorbidity ( Deyo-Charlson index ) , American Society of Anesthesiologists class , implant fixation , and underlying diagnosis with risk of infection . RESULTS A total of 2,207 patients , with a mean age of 65 years ( SD , 12 years ) , 53 % of whom were women , underwent 2,588 primary TSAs . Mean follow-up was 7 years ( SD , 6 years ) , and the mean body mass index was 30 kg/m(2 ) ( SD , 6 kg/m(2 ) ) . The American Society of Anesthesiologists class was 1 or 2 in 61 % of cases . Thirty-two confirmed deep periprosthetic infections occurred during follow-up . In earlier years , Staphylococcus predominated ; in recent years , Propionibacterium acnes was almost as common . The 5- , 10- , and 20-year prosthetic infection-free rates were 99.3 % ( 95 % confidence interval [ CI ] , 98.9 - 99.6 ) , 98.5 % ( 95 % CI , 97.8 - 99.1 ) , and 97.2 % ( 95 % CI , 96.0 - 98.4 ) , respectively . On multivariable analysis , a male patient had a significantly higher risk of deep periprosthetic infection ( hazard ratio , 2.67 [ 95 % CI , 1.22 - 5.87 ] ; P = .01 ) and older age was associated with lower risk ( hazard ratio , 0.97 [ 95 % CI , 0.95 - 1.00 ] per year ; P = .05 ) . CONCLUSIONS The periprosthetic infection rate was low at 20-year follow-up . Male gender and younger age were significant risk factors for deep periprosthetic infections after TSA . Future studies should investigate whether differences in bone morphology , medical comorbidity , or other factors are underlying these associations We evaluated all revisions performed from March 1996 to December 2008 and compared complications , mortality , and clinical outcomes between patients 80 years and older and patients younger than 80 years . Data were collected prospect ively . There were 325 revisions , 84 ( 25.8 % ) in patients 80 years and older and 241 in patients younger than 80 years ( 62 % revision for aseptic loosening in both groups ) . The mean follow-up was 4.3 years . The results , 80 years and older vs younger than 80 years , revealed the following : mortality , 5 % vs 0 % 3 months postoperatively ; medical complications in 23.8 % vs 6.2 % ; postoperative fractures , 9.5 % vs 2.5 % ; and improved Merle d'Aubigné scores from 9.6 to 13.0 vs 10.4 to 14.3 . Revision total hip arthroplasty in patients 80 years and older was associated with substantial clinical improvement and patient satisfaction . However , medical complications and 90-day mortality were higher , and postoperative fractures occurred more frequently AIM To estimate the incidence rate and risk factors of  surgical site infections in the orthopedic wards in a major teaching hospital in Serbia . METHODS A 6-month prospect i ve cohort study , with 30 days of patient follow-up after surgery , was conducted at the teaching hospital in Bel grade . We collected patients ' basic demographic data and data on underlying disease status , surgical procedures , preoperative preparation of patients , and antibiotic prophylaxis . The National Nosocomial Infections Surveillance ( NNIS ) risk index was computed for each patient . Descriptive and logistic regression analyses were performed to determine risk factors for surgical site infections . RESULTS Assessment of 277 patients after operation revealed surgical site infection in 63 patients . In 3 ( 4.8 % ) of them , surgical site infections were detected after hospital discharge . The overall incidence rate of surgical site infections was 22.7 % ( 95 % confidence interval [ 95 % CI ] , 17.5 - 29.1 ) . The incidence increased from 13.2 % in clean wounds to 70.0 % in dirty wounds . The rates of surgical site infection for the NNIS risk index classes 0 to 3 were 8.1 % ( 13 of 161 ) , 36.4 % ( 32 of 88 ) , 63.0 % ( 17 of 27 ) , and 100 % ( 1 of 1 ) ( P<0.001 ; chi2 test ) . Multivariate logistic regression analysis identified the following independent risk factors for surgical site infections : greater number of persons in the operating room ( odds ratio [ OR ] , 1.28 ; 95 % CI , 1.02 - 1.60 ) , contaminated or dirty wounds ( OR , 12.09 ; 95 % CI , 5.56 - 26.28 ) , and American Society of Anesthesiologists ' ( ASA ) score > 2 ( OR , 3.47 ; 95 % CI , 1.51 - 7.95 ) . In patients who were shaved with a razor , the period of 12 or more hours between shaving and intervention was also an independent risk factor ( OR , 2.77 ; 95 % CI , 1.22 - 6.28 ) . CONCLUSION There is a high incidence of surgical site infections  in orthopedic patients in Serbia in comparison with developed countries and some developing countries . Points for intervention could be reduction of personnel during surgery , better treatment of wounds , decreasing ASA score , and reduction of the time between surgical site shaving and the intervention We conducted a r and omized controlled trial to compare efficacy of an occlusive antimicrobial barrier dressing and a st and ard surgical dressing in patients who underwent primary total joint arthroplasty . Two hundred sixty-two patients were r and omized to receive either an occlusive dressing or a st and ard dressing . Wounds were closed in identical fashion . Outcomes included wound complications , dressing changes , and patient satisfaction . With use of occlusive dressing ( vs st and ard dressing ) , wound complications ( including skin blistering ) were significantly ( P = 0.15 ) reduced ; there were significantly ( P < .0001 ) fewer dressing changes ; and patient satisfaction was significantly ( P < .0001 ) higher . Use of occlusive dressings can reduce wound complications and promote wound healing after total joint arthroplasty OBJECTIVE Dislocation is a well-known complication after  total hip arthroplasty ( THA ) , and is the second-highest cause of revision surgery . Our objective was to assess the effect of preoperative patient education on the occurrence of  hip dislocation  within 6 months after primary THA . METHODS Between 1998 and 2007 , we conducted a prospect i ve cohort study at the Geneva University Hospital Department of Orthopaedic Surgery , including all primary THAs performed via an anterolateral transgluteal approach with the use of a 28-mm diameter head .  The preoperative education session was introduced in June 2002 and included advice on muscle strengthening exercises and postoperative restrictions of range of motion as a means of preventing dislocation . The main outcome was the incidence of dislocation within 6 months of surgery . RESULTS A total of 597 patients who underwent 656 THAs between June 2002 and June 2007 participated in the education session , whereas 1,641 patients who underwent 1,945 procedures did not . Forty-six dislocations occurred over the study period , 5 ( 0.8 % ) in participants and 41 ( 2.1 % ) in non participants ( absolute risk reduction 1.3 % ; 95 % confidence interval [ 95 % CI ] 0.4 , 2.3 ) , with the time interval between surgery and dislocation being significantly shorter among participants ( 0.2 versus 1.2 months ) . Non participants had a 2.8 times higher risk of dislocation than participants ( unadjusted odds ratio [ OR ] 2.80 ; 95 % CI 1.10 , 7.13 ) . Adjustment for age , sex , comorbidities , and prior surgery did not change the results ( adjusted OR 2.79 ; 95 % CI 1.09 , 7.15 ) . CONCLUSION Our findings suggest that participation in a preoperative patient education session may reduce the risk of dislocation within 6 months after THA OBJECTIVE To identify risk factors associated with the development of surgical-site infection ( SSI )  following total knee arthroplasty ( TKA ) . DESIGN A case-control study . SETTING A 1,100-bed , university-affiliated , tertiary-care teaching hospital . METHODS Case- patients with SSI occurring up to 1 year following primary TKA performed between January 1999 and December 2001 were identified prospect ively by infection control practitioners using National Nosocomial Infections Surveillance ( NNIS ) System methods . Three control- patients were selected for each case-patient , matched by date of surgery . Stepwise logistic regression analysis was used to determine the relation of potential risk factors to the development of infection . RESULTS Twenty-two patients with infections ( 6 superficial and 16 deep ) were identified .  Infection rates per year were 0.95 % , 1.07 % , and 1.19 % in 1999 , 2000 , and 2001 , respectively . Logistic regression analysis identified two variables independently associated with the development of infection : the use of closed suction drainage  ( odds ratio [ OR ] , 7.0 ; 95 % confidence interval [ CI95 ] , 2.1 - 25.0 ; P = .0015 ) and increased international normalized ratio ( INR ) ( OR , 2.4 ; CI95 , 1.1 - 5.7 ; P = .035 ) . Factors not statistically associated with the development of infection included age , NNIS System risk index score , presence of various comorbidities , surgeon , duration of procedure or tourniquet time , type of bone cement or prosthesis used , or receipt of blood product transfusions . CONCLUSIONS The use of closed suction drainage and a high postoperative INR were associated with the development of SSI following TKA . Avoiding the use of surgical drains and careful monitoring of anticoagulant prophylaxis in patients undergoing TKA should reduce the risk of infection This prospect i ve study aim ed to determine the surgical site infection ( SSI ) rate and associated risk factors was carried in a general surgical ward at Liaquat University Hospital Jamshoro . A total of 460 patients requiring elective general surgery from July 2005 to June 2006 were included in this study . All four surgical wound categories were included . Primary closure was employed in all cases . Patients were followed up to 30th day postoperatively . All cases were evaluated for postoperative fever , redness , swelling of wound margins and collection of pus . Cultures were taken from all the cases with any of the above finding . Mean + /- SD age of the patients was 38.8 + /- 17.4 years with male to female ratio of 1.5:1 . The overall rate of surgical site infection was 13.0 % . The rate of wound infection was 5.3 % in clean operations , 12.4 % in clean-contaminated , 36.3 % in contaminated and 40 % in dirt-infected cases . Age , use of surgical drain , duration of operation and wound class were significant risk factors for increased surgical site infection ( P < 0.05 ) . Postoperative hospital stay was double in cases who had surgical site infection . Sex , haemoglobin level and diabetes were not statistically significant risk factors ( P > 0.05 ) . In conclusion , surgical site infection causes considerable morbidity and economic burden . The routine reporting of SSI rates stratified by potential risk factors associated with increased risk of infection is highly recommended
Newer infection prevention techniques , such as preoperative antiseptic scrubbing , are affected and may help reduce the infection rate , while traditionally accepted methods of prophylaxis such as laminar-flow operating rooms and body exhaust suits may raise the infection rate
Despite advances in our underst and ing of surgical site infections following total joint arthroplasty , this serious surgical complication continues to represent a substantial economic burden for the patient , the treating institution and the healthcare system .
After increasing for the past decade , infection rates have stabilized at 1.6 % ; however , the total cost is projected to increase with the total number of revision procedures performed .