Two types of national registers surveil infections after primary total hip arthroplasty (THA) in Norway: The National surveillance system for surgical site infections (NOIS) that surveil all primary THAs 30 days postoperatively for surgical site infections (SSI), and the Norwegian Arthroplasty Register (NAR) that follow all THAs until any surgical reoperation/revision or the death of the patient. Since these registers report on the same THAs we assessed correspondence between and time trends for the two registers in period 2013 to 2022. All reported THAs were included. The THAs were matched on a group level according to sex, age and ASA-class. In addition to descriptive statistics, adjusted Cox regression analyses were performed with adjustment for sex, age group (<45, 45-54, 55-64, 65-74, 75-84, >85 years) and ASA-class (1, 2, 3, 4 and missing). Changes in annual incidence and adjusted hazard rate (aHR) was calculated. Endpoints in the NOIS were 30-Days SSI and 30-Days reoperation for SSI. Endpoints in the NAR were 30-Days and 1-Year reoperation for periprosthetic joint infection (PJI).Aim
Method
The current recommendation in Norway is to use four doses of a first-generation cephalosporin (cefazolin or cephalotin) as systemic antibiotic prophylaxis (SAP) the day of surgery in primary joint arthroplasty. Due to shortage of supply, scientific development, changed courses of treatment and improved antibiotic stewardship, this recommendation has been disputed. We therefore wanted to assess if one dose of SAP was non-inferior to four doses in preventing periprosthetic joint infection (PJI) in primary joint arthroplasty. We included patients with primary hip- and knee arthroplasties from the Norwegian Arthroplasty Register and the Norwegian Hip Fracture Register for the period 2005-2023. We included the most used SAPs (cephalotin, cefazolin, cefuroxime, cloxacillin and clindamycin), administered as the only SAP in 1-4 doses, starting preoperatively. Risk of revision (Hazard rate ratio; HRR) for PJI was estimated by Cox regression analyses with adjustment for sex, age, ASA class, duration of surgery, reason for- and type of arthroplasty, and year of primary arthroplasty. The outcome was 1-year reoperation or revision for PJI. Non-inferiority margins were calculated for 1, 2 and 3 doses versus reference of 4 doses of SAP at the day of surgery, against a predetermined limit of 15% increased risk of PJI.Aim
Method
Previous publications have reported an increased but levelling out risk of revision for infection after total hip arthroplasty (THA) in Norway. We assessed the changes in risk of major (cup and/or stem, 1- or 2-stage) and minor revisions (debridement, exchange of modular parts, antibiotics and implant retention (DAIR)) for infection after primary THAs reported to the Norwegian Arthroplasty Register (NAR) over the period 2005-2022. Primary THAs reported to the NAR from 2005 to 2022 were included. Time was stratified into time periods (2005-2009, 2010-2018, 2019-2022) based on a previous publication. Cox regression analyses, adjusted for sex, age and ASA-classification, with the first revision for infection were performed.Background and purpose
Patients and methods
Ankle fracture surgery comes with a risk of fracture-related infection (FRI). Identifying risk factors are important in preoperative planning, in management of patients, and for information to the individual patient about their risk of complications. In addition, modifiable factors can be addressed prior to surgery. The aim of the current paper was to identify risk factors for FRI in patients operated for ankle fractures. A cohort of 1004 patients surgically treated for ankle fractures at Haukeland University hospital in the period of 2015–2019 was studied retrospectively. Patient charts and radiographs were assessed for the diagnosis of FRI. Binary logistic regression was used in analyses of risk factors. Regression coefficients were used to calculate the probability for FRI based on the patients’ age and presence of one or more risk factors.Aim
Method
Surgical treatment of ankle fractures comes with a substantial risk of complications, including infection. An unambiguously definition of fracture-related infections (FRI) has been missing. Recently, FRI has been defined by a consensus group with a diagnostic algorithm containing suggestive and confirmatory criteria. The aim of the current study was to report the prevalence of FRI in patients operated for ankle fractures and to assess the applicability of the diagnostic algorithm from the consensus group. Records of all patients with surgically treated ankle fractures from 2015 to 2019 were retrospectively reviewed for signs of postoperative infections. Patients with suspected infection were stratified according to Aim
Method
Previous publications have suggested that the incidence of revisions due to infection after THA is increasing. We performed updated time-trend analyses of risk and timing of revision due to infection after primary THAs in the Nordic countries during the period 2004–2018. 569,463 primary THAs reported to the Nordic Arthroplasty Register Association from 2004 through 2018 were studied. We estimated adjusted hazard ratios (aHR) with 95% confidence interval by Cox regression with the first revision due to infection after primary THA as endpoint. The risk of revision was investigated. In addition, we explored changes in the time span from primary THA to revision due to infection.Aim
Methods
In recent years, many studies on We investigated the reported Aim
Methods
The aim of this study was to assess the influence of the true operating room (OR) ventilation on the risk of revision due to infection after primary total hip arthroplasty (THA) reported to the Norwegian Arthroplasty Register (NAR). 40 orthopedic units were included during the period 2005 – 2015. The Unidirectional airflow (UDAF) systems were subdivided into small-area, low-volume, vertical UDAF (lvUDAF) (volume flow rate (VFR) (m3/hour) <=10,000 and diffuser array size (DAS) (m2) <=10); large-area, high-volume, vertical UDAF (hvUDAF) (VFR >=10,000 and DAS >=10) and Horizontal UDAF (H-UDAF). The systems were compared to conventional, turbulent ventilation (CV) systems. The association between revision due to infection and OR ventilation was assessed using Cox regression models, with adjustments for sex, age, indication for surgery, ASA-classification, method of fixation, modularity of the components, duration of surgery, in addition to year of primary THA. All included THAs received systemic, antibiotic prophylaxis.Aim
Method
Periprosthetic joint infection (PJI) after knee arthroplasty surgery remains a serious complication. Yet, there is no international consensus on the surgical treatment of PJI. The purpose was to assess the prosthesis survival rates, risk of re-revision, and mortality rate following the different surgical strategies (1-stage or 2-stage implant revision, and irrigation and debridement (IAD) with implant retention) used to treat PJI. The study was based on 653 total knee arthroplasties (TKAs) revised due to PJI in the period 1994 to 2016. Kaplan-Meier (KM) and multiple Cox regression analyses were performed to assess the survival rate of these revisions and the risk of re-revisions. We also studied the mortality rates at 90 days and 1 year after revision for PJI.Background
Methods
To see what surgical strategy was used in treating infected total hip arthroplasties (THA), relative to bacterial findings, level of inflammation, length of antibiotic treatment (AB) and re-revisions. Further, to assess the results of treatment after three months and one year. We used our national arthroplasty register (NAR) to identify THA revised for deep infection from 2004–2015 reported from our hospital. We identified the strategy of revision, i.e. one-stage exchange (one-stage), two-stage exchange (two-stage), debridement and implant retention (DAIR), or Girdlestone, and reported re-revisions for infection. We defined cure as no AB, no need for further surgery and joint with prosthesis (not Girdlestone). From the hospitals’ medical records we retrieved bacterial findings from the revisions, level of C-reactive protein (CRP), type of antibiotics given, duration of antibiotic therapy and clinical data regarding the patients. The information reported to the NAR was also validated.Aim
Method
The aim of this study was to validate the information on operating room ventilation reported to the Norwegian Arthroplasty Register (NAR) and to assess the influence of this ventilation on the risk of revision due to infection after primary total hip arthroplasty (THA). Current and previous ventilation systems were evaluated together with the hospitals head engineer in 40 orthopaedic hospitals. The ventilation system of each operating room was assessed and confirmed as either conventional ventilation, vertical laminar airflow (LAF) or horizontal LAF. We then identified cases of first revision due to deep infection after primary THA and the type of ventilation system reported to the NAR in the period 1987–2014. The association between revision due to infection and operating room ventilation was estimated by relative risks (RR) in a Cox regression model.Aim
Method
The aim of this study was to validate the information on operating room ventilation reported to the Norwegian Arthroplasty Register (NAR). We then wanted to assess the influence of operating room ventilation on the rate of revision due to infection after primary THA performed in operating rooms with conventional ventilation, “greenhouse”–ventilation and Laminar Airflow ventilation (LAF). We identified cases of THA revisions due to deep infection and the type of ventilation system reported to the NAR from the primary THA. We included 5 orthopaedic units reporting 17947 primary THAs and 136 (0.8%) revisions due to infection during the 28 year inclusion period from 1987 to 2014. The hospitals were visited and the current and previous ventilation systems were evaluated together with the hospitals head engineer, and the factual ventilation on the specific operating rooms was thereby assessed. The association between revision due to infection and operating room ventilation was estimated by calculating relative risks (RR) in a Cox regression model. 73% of the primary THAs were performed in a room with LAF, in contrast to the reported 80 % of LAF. There was similar risk of revision due to infection after THA performed in operating rooms with laminar air flow compared to conventional ventilation (RR=0.7, 95 % CI: 0.2–2.3) and after THA performed in operating rooms with “greenhouse”-ventilation compared to conventional ventilation (RR=1.2, 0.1–11). Surgeons are not fully aware of what kind of ventilation there is in the operating room. This study may indicate that, concerning reduction in incidence of THA infection, LAF does not justify the substantial installation cost. The numbers in the present study are too small to conclude strongly. Therefore, the study will be expanded to include all hospitals reporting to the NAR.
