SURGICAL SITE INFECTION AFTER TOTAL KNEE ARTHROPLASTY
Surgical Site Infection After Total Knee Arthroplasty : A
Descriptive Study
Sadik Bilgen1, Gokay Eken2
1Assoc. Professor, Department of Orthopedic Surgery, Uludag University School of Medicine, Bursa, Turkey
2Chief Assistant, Department of Orthopedic Surgery, Uludag University School of Medicine, Bursa, Turkey
Abstract— Joint replacement operations which are applied to reduce the pain and increase the
movement capacity are among the surgical procedures that are used mostly nowadays. Even though a
dramatic recovery is seen in the life of the patient after total knee prosthesis, possible prosthesis
infection increases cost and causes high morbidity. This study was conducted with the aim to determine
rates of surgical site infection after performing primer total knee prothesis operation in our clinic.
Furthermore, it has been intended to understand risk factors which may cause infection and then take
precautions. This study was conducted from January 2008 to January 2013, 252 knees underwent
primary total knee arthroplasty operations. Among these patients infection rates, relationship to risk
factors and infection treatments were analysed. It was observed that iIn 252 knees, 10 (4%) superficial
infections were found, debridement and antibiotics were applied to 3 knees out of 10 and only antibiotic
treatment was applied to the rest 7 knees. Deep infection was detected in 4 knees (1,6%) out of 252.
Acute deep infection in 1 knee and recovery was provided with debridement and intravenous antibiotics
treatment. Late deep infection was not detected in any of patients. Delayed deep infection was detected
in 3 (1,1%) of these knees though. Among all risk factors only increased body mass index showed
increased superficial wound infection rate. It can be concluded that among the factors like rheumatoid
arthritis, diabetes, age, gender, body mass index, just body mass index has an impact on superficial
infection rate. Our infection rates were comparable to rates mentioned in universal literature for
primary total knee replacement operations.
Key words: Joint replacement, Surgical site Infection, Arthroplasty
I. INTRODUCTION
With the aging population, joint diseases are seen more often today. Pain and limitation of movement
ability in these diseases occur and with joint injury over time decrease life quality of the patients
considerably. Therefore, joint replacement operations which are applied to reduce the pain and increase
the movement capacity are among the surgical procedures that are used mostly now a day. Even though
a dramatic recovery is seen in the life of the patient after total knee prosthesis, possible prosthesis
infection increases cost and causes high morbidity. According to the research applied in a number of
different centers, 0,5%-5% infection rates have been reported after primer total knee arthroplasty. 1,2.3
Infection mechanism takes place through direct transmission of disease or haematogenous. Some
examples of direct transmission are unclean operating theatres, transmission from an infected patient,
usage of torn surgical gloves, negligence of the operating staff about sterility and these cases can be
taken under control. Transmission through haematogenous occurs following bacteremia. For instance,
Streptococcus viridans or peptostrepotococcus after dental intervention, staphycoccusspecies after skin
International Multispecialty Journal of Health (IMJH) ISSN:[2395-6291] [Vol-2, Issue-2, February- 2016]
Page | 2
infections and gram negative enterococcusand anaerobic infections after gastrointestinal genitourinary
infections can be experienced. 4
Swelling, pain and decrease in functional capacity at the knee joint occur following knee arthroplasty
and as the infection progresses, periarticular bone stock decreases and implant loosenings. Patients who
are not treated sufficiently may experience sepsis and life threatening septic shock. In addition, it has
been reported that infected knee prothesis prolongs the duration of hospital stay and increases the cost
considerably. 5
In this research, it has been aimed to determine rates of surgical site infection after performing primer
total knee prosthes is operation in Uludağ University Medical Faculty Orthopedics and Traumatology
Clinic. Furthermore, it has been intended to understand risk factors which may cause infection and then
to take specific precautions.
