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The study followed 56,216 primary total knee arthroplasties recorded in a total joint replacement registry from 2001 to 2009, in which 63 percent were performed in female patients. Incidence of deep surgical site infection was 0.72 percent, and a fully adjusted model showed patient risk factors including:
• BMI of 35 or higher;
• Diabetes mellitus;
• Male sex;
• American Society of Anesthesiology score of three or greater;
• Osteonecrosis;
• Posttraumatic arthritis.
Protective surgical factors included:
• Use of antibiotic irrigation;
• Bilateral procedures;
• Lower hospital volume.
Surgical risk factors were:
• Quadriceps-release exposure;
• Antibiotic-laden cement use;
• Operative time increased risk by 9 percent per 15 minute increment.
Study authors recommended using comprehensive infection surveillance systems and a total joint replacement registry to further identify factors associated with infection risk for total knee arthroplasty patients.
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