EVALUATION OF INFECTIOUS RISK (DEEP INFECTION) IN A CONSECUTIVE SERIES OF 790 FIRST-INTENTION TOTAL HIP ARTHROPLASTIES PERFORMED IN A UNIVERSITY HOSPITAL

Abstract

Purpose: Deep infections of the operative bed are rare but serious complications of first-intention total hip arthroplasty. Data from French series are scarce. We present a study of incidence, characteristic features and potential risk factors using a consecutive series of 790 implants performed during first-intention procedures in the same university hospital.

Material and methods: All patients who underwent first-intention surgery from November 1995 to May 1999 were included. We collected demographic, clinical, and therapeutic data. Deep infection was defined as bacteriological demonstration of the infectious agent from at least two intra-operative specimens during the revision procedure. Patient follow-up ranged from one month to four years. Univariate analysis was used to search for potential risk factors. The chi-square and Fischer exact tests were applied.

Results: Overall incidence was 1.77 deep infections for 100 operations (95%IC 0.84–2.7). Mean time to development ranged from 14 days to 32 months. Eleven infections were recognised within the first year and three after one year. Two risk factors were identified: absence of systemic antibiotic prophylaxis (relative risk = 4.74, p=0.03), and drainage discharge after 48 hr (relative risk = 3.62, p=0.02). Other variables associated with infection with a relative risk greater than 2 were obesity, corticosteroid therapy, and haematoma or postoperative wound healing problem.

Conclusion: The incidence found in this series is slightly higher than generally described in other countries. This study has incited us to revisit our protocols for preoperative skin preparation and to establish a systemic antibiotic prophylaxis.