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J Knee Surg 2022; 35(09): 1023-1043
DOI: 10.1055/s-0041-1740394
Original Article

The Utility of Perioperative Products for the Prevention of Surgical Site Infections in Total Knee Arthroplasty and Lower Extremity Arthroplasty: A Systematic Review

Hytham S. Salem
1   Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
2   Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Alain E. Sherman
1   Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
,
Zhongming Chen 
1   Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
2   Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Giles R. Scuderi
1   Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
,
Michael A. Mont
1   Northwell Health Orthopaedics, Lenox Hill Hospital, New York, New York
2   Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
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Abstract

Surgical site infections (SSIs) are among the most prevalent and devastating complications following lower extremity total joint arthroplasty (TJA). Strategies to reduce the rates can be divided into preoperative, perioperatives, and postoperative measures. A multicenter trial is underway to evaluate the efficacy of implementing a bundled care program for SSI prevention in lower extremity TJA including: (1) nasal decolonization; (2) surgical skin antisepsis; (3) antimicrobial incise draping; (4) temperature management; and (5) negative-pressure wound therapy for selected high-risk patients. The purposes of this systematic review were to provide a background and then to summarize the available evidence pertaining to each of these SSI-reduction strategies with special emphasis on total knee arthroplasty. A systematic review of the literature was conducted in accordance with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. Five individual literature searches were performed to identify studies evaluating nasal decolonization temperature management, surgical skin antisepsis, antimicrobial incise draping, and negative-pressure wound therapy. The highest level of evidence reports was used in each product review, and if there were insufficient arthroplasty papers on the particular topic, then papers were further culled from the surgical specialties to form the basis for the review. There was sufficient literature to assess all of the various prophylactic and preventative techniques. All five products used in the bundled program were supported for use as prophylactic agents or for the direct reduction of SSIs in both level I and II studies. This systematic review showed that various pre-, intra-, and postoperative strategies are efficacious in decreasing the risks of SSIs following lower extremity TJA procedures. Thus, including them in the armamentarium for SSI-reduction strategies for hip and knee arthroplasty surgeons should decrease the incidence of infections. We expect that the combined use of these products in an upcoming study will support these findings and may further enhance the reduction of total knee arthroplasty SSIs in a synergistic manner.

Keywords

total knee arthroplasty - perioperative products - surgical site infections - Systematic Review


Publication History

Received: 05 August 2021

Accepted: 22 October 2021

Article published online:
07 December 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Yang G, Zhu Y, Zhang Y. Prognostic risk factors of surgical site infection after primary joint arthroplasty: a retrospective cohort study. Medicine (Baltimore) 2020; 99 (08) e19283
    CrossrefPubMedGoogle Scholar
  • 2 Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Joint Surg Am 2013; 95 (09) 775-782
    CrossrefPubMedGoogle Scholar
  • 3 Teo BJX, Yeo W, Chong HC, Tan AHC. Surgical site infection after primary total knee arthroplasty is associated with a longer duration of surgery. J Orthop Surg (Hong Kong) 2018; 26 (02) 2309499018785647
    CrossrefPubMedGoogle Scholar
  • 4 Ridgeway S, Wilson J, Charlet A, Kafatos G, Pearson A, Coello R. Infection of the surgical site after arthroplasty of the hip. J Bone Joint Surg Br 2005; 87 (06) 844-850
    CrossrefPubMedGoogle Scholar
  • 5 Barie PS, Eachempati SR. Surgical site infections. Surg Clin North Am 2005; 85 (06) 1115-1135 , viii–ix
    CrossrefPubMedGoogle Scholar
  • 6 Izakovicova P, Borens O, Trampuz A. Periprosthetic joint infection: current concepts and outlook. EFORT Open Rev 2019; 4 (07) 482-494
    CrossrefPubMedGoogle Scholar
  • 7 Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 2012; 27 (8, Suppl): 61-5.e1
    CrossrefPubMedGoogle Scholar
  • 8 Springer BD, Cahue S, Etkin CD, Lewallen DG, McGrory BJ. Infection burden in total hip and knee arthroplasties: an international registry-based perspective. Arthroplast Today 2017; 3 (02) 137-140
    CrossrefPubMedGoogle Scholar
  • 9 Premkumar A, Kolin DA, Farley KX. et al. Projected economic burden of periprosthetic joint infection of the hip and knee in the United States. J Arthroplasty 2021; 36 (05) 1484-1489.e3
    CrossrefPubMedGoogle Scholar
  • 10 Percival SL, Emanuel C, Cutting KF, Williams DW. Microbiology of the skin and the role of biofilms in infection. Int Wound J 2012; 9 (01) 14-32
    CrossrefPubMedGoogle Scholar
  • 11 Noble WC. The production of subcutaneous staphylococcal skin lesions in mice. Br J Exp Pathol 1965; 46 (03) 254-262
    PubMedGoogle Scholar
  • 12 Kong HH, Segre JA. Skin microbiome: looking back to move forward. J Invest Dermatol 2012; 132 (3, Pt 2): 933-939
    CrossrefPubMedGoogle Scholar
  • 13 Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am 2009; 91 (01) 128-133
    CrossrefPubMedGoogle Scholar
  • 14 Bozic KJ, Kurtz SM, Lau E. et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 2010; 468 (01) 45-51
    CrossrefPubMedGoogle Scholar
  • 15 Anderson MJ, David ML, Scholz M. et al. Efficacy of skin and nasal povidone-iodine preparation against mupirocin-resistant methicillin-resistant Staphylococcus aureus and S. aureus within the anterior nares. Antimicrob Agents Chemother 2015; 59 (05) 2765-2773
    CrossrefPubMedGoogle Scholar
  • 16 Rezapoor M, Nicholson T, Tabatabaee RM, Chen AF, Maltenfort MG, Parvizi J. Povidone-iodine-based solutions for decolonization of nasal staphylococcus aureus: a randomized, prospective, placebo-controlled study. J Arthroplasty 2017; 32 (09) 2815-2819
    CrossrefPubMedGoogle Scholar
  • 17 Jacobson C, Osmon DR, Hanssen A. et al. Prevention of wound contamination using DuraPrep solution plus Ioban 2 drapes. Clin Orthop Relat Res 2005; 439 (439) 32-37
    PubMedGoogle Scholar
  • 18 Morrison TN, Chen AF, Taneja M, Küçükdurmaz F, Rothman RH, Parvizi J. Single vs repeat surgical skin preparations for reducing surgical site infection after total joint arthroplasty: a prospective, randomized, double-blinded study. J Arthroplasty 2016; 31 (06) 1289-1294
    CrossrefPubMedGoogle Scholar
  • 19 Hesselvig AB, Arpi M, Madsen F, Bjarnsholt T, Odgaard A. ICON Study Group. Does an antimicrobial incision drape prevent intraoperative contamination? A randomized controlled trial of 1187 patients. Clin Orthop Relat Res 2020; 478 (05) 1007-1015
    CrossrefPubMedGoogle Scholar
  • 20 Allegranzi B, Bischoff P, de Jonge S. et al; WHO Guidelines Development Group. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis 2016; 16 (12) e276-e287
    CrossrefPubMedGoogle Scholar
  • 21 Lindsay W, Bigsby E, Bannister G. Prevention of infection in orthopaedic joint replacement. J Perioper Pract 2011; 21 (06) 206-209
    PubMedGoogle Scholar
  • 22 Matar WY, Jafari SM, Restrepo C, Austin M, Purtill JJ, Parvizi J. Preventing infection in total joint arthroplasty. J Bone Joint Surg Am 2010; 92 (Suppl. 02) 36-46
    CrossrefPubMedGoogle Scholar
  • 23 Merle V, Germain JM, Chamouni P. et al. Assessment of prolonged hospital stay attributable to surgical site infections using appropriateness evaluation protocol. Am J Infect Control 2000; 28 (02) 109-115
    CrossrefPubMedGoogle Scholar
  • 24 Wilcox MH, Hall J, Pike H. et al. Use of perioperative mupirocin to prevent methicillin-resistant Staphylococcus aureus (MRSA) orthopaedic surgical site infections. J Hosp Infect 2003; 54 (03) 196-201
    CrossrefPubMedGoogle Scholar
  • 25 Bode LG, Kluytmans JA, Wertheim HF. et al. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 2010; 362 (01) 9-17
    CrossrefPubMedGoogle Scholar
  • 26 Phillips M, Rosenberg A, Shopsin B. et al. Preventing surgical site infections: a randomized, open-label trial of nasal mupirocin ointment and nasal povidone-iodine solution. Infect Control Hosp Epidemiol 2014; 35 (07) 826-832
    CrossrefPubMedGoogle Scholar
  • 27 Caffrey AR, Quilliam BJ, LaPlante KL. Risk factors associated with mupirocin resistance in meticillin-resistant Staphylococcus aureus. J Hosp Infect 2010; 76 (03) 206-210
    CrossrefPubMedGoogle Scholar
  • 28 Kirkland KB, Briggs JP, Trivette SL, Wilkinson WE, Sexton DJ. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol 1999; 20 (11) 725-730
    CrossrefPubMedGoogle Scholar
  • 29 Letzelter J, Hill JB, Hacquebord J. An overview of skin antiseptics used in orthopaedic surgery procedures. J Am Acad Orthop Surg 2019; 27 (16) 599-606
    CrossrefPubMedGoogle Scholar
  • 30 Berríos-Torres SI, Umscheid CA, Bratzler DW. et al; Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 2017; 152 (08) 784-791
    CrossrefPubMedGoogle Scholar
  • 31 Harris JD, McCormick FM, Abrams GD. et al. Complications and reoperations during and after hip arthroscopy: a systematic review of 92 studies and more than 6,000 patients. Arthroscopy 2013; 29 (03) 589-595
    CrossrefPubMedGoogle Scholar
  • 32 Savage JW, Weatherford BM, Sugrue PA. et al. Efficacy of surgical preparation solutions in lumbar spine surgery. J Bone Joint Surg Am 2012; 94 (06) 490-494
    CrossrefPubMedGoogle Scholar
  • 33 Hemani ML, Lepor H. Skin preparation for the prevention of surgical site infection: which agent is best?. Rev Urol 2009; 11 (04) 190-195
    PubMedGoogle Scholar
  • 34 Alexander JW, Aerni S, Plettner JP. Development of a safe and effective one-minute preoperative skin preparation. Arch Surg 1985; 120 (12) 1357-1361
    CrossrefPubMedGoogle Scholar
  • 35 Fairclough JA, Johnson D, Mackie I. The prevention of wound contamination by skin organisms by the pre-operative application of an iodophor impregnated plastic adhesive drape. J Int Med Res 1986; 14 (02) 105-109
    CrossrefPubMedGoogle Scholar
  • 36 Allen MW, Jacofsky DJ. Normothermia in arthroplasty. J Arthroplasty 2017; 32 (07) 2307-2314
    CrossrefPubMedGoogle Scholar
  • 37 Kurz A, Sessler DI, Lenhardt R. Study of Wound Infection and Temperature Group. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med 1996; 334 (19) 1209-1215
    CrossrefPubMedGoogle Scholar
  • 38 Mahoney CB, Odom J. Maintaining intraoperative normothermia: a meta-analysis of outcomes with costs. AANA J 1999; 67 (02) 155-163
    PubMedGoogle Scholar
  • 39 Hohn DC, MacKay RD, Halliday B, Hunt TK. Effect of O2 tension on microbicidal function of leukocytes in wounds and in vitro. Surg Forum 1976; 27 (62) 18-20
    PubMedGoogle Scholar
  • 40 Hunt TK, Pai MP. The effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis. Surg Gynecol Obstet 1972; 135 (04) 561-567
    PubMedGoogle Scholar
  • 41 Lehtinen SJ, Onicescu G, Kuhn KM, Cole DJ, Esnaola NF. Normothermia to prevent surgical site infections after gastrointestinal surgery: holy grail or false idol?. Ann Surg 2010; 252 (04) 696-704
    CrossrefPubMedGoogle Scholar
  • 42 Sessler DI, Rubinstein EH, Moayeri A. Physiologic responses to mild perianesthetic hypothermia in humans. Anesthesiology 1991; 75 (04) 594-610
    CrossrefPubMedGoogle Scholar
  • 43 Albrecht M, Gauthier R, Leaper D. Forced-air warming: a source of airborne contamination in the operating room?. Orthop Rev (Pavia) 2009; 1 (02) e28
    PubMedGoogle Scholar
  • 44 Ackermann W, Fan Q, Parekh AJ, Stoicea N, Ryan J, Bergese SD. Forced-air warming and resistive heating devices. Updated perspectives on safety and surgical site infections. Front Surg 2018; 5: 64-64
    CrossrefPubMedGoogle Scholar
  • 45 Haeberle HS, Navarro SM, Samuel LT. et al. No evidence of increased infection risk with forced-air warming devices: a systematic review. Surg Technol Int 2017; 31: 295-301
    PubMedGoogle Scholar
  • 46 Newman JM, Siqueira MBP, Klika AK, Molloy RM, Barsoum WK, Higuera CA. Use of closed incisional negative pressure wound therapy after revision total hip and knee arthroplasty in patients at high risk for infection: a prospective, randomized clinical trial. J Arthroplasty 2019; 34 (03) 554.e1-559.e1
    CrossrefPubMedGoogle Scholar
  • 47 Redfern RE, Cameron-Ruetz C, O'Drobinak SK, Chen JT, Beer KJ. Closed incision negative pressure therapy effects on postoperative infection and surgical site complication after total hip and knee arthroplasty. J Arthroplasty 2017; 32 (11) 3333-3339
    CrossrefPubMedGoogle Scholar
  • 48 Shiroky J, Lillie E, Muaddi H, Sevigny M, Choi WJ, Karanicolas PJ. The impact of negative pressure wound therapy for closed surgical incisions on surgical site infection: a systematic review and meta-analysis. Surgery 2020; 167 (06) 1001-1009
    CrossrefPubMedGoogle Scholar
  • 49 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. PLoS Med 2009; 6 (07) e1000097
    Google Scholar
  • 50 Burns PB, Rohrich RJ, Chung KC. The levels of evidence and their role in evidence-based medicine. Plast Reconstr Surg 2011; 128 (01) 305-310
    CrossrefPubMedGoogle Scholar
  • 51 Maslow J, Hutzler L, Cuff G, Rosenberg A, Phillips M, Bosco J. Patient experience with mupirocin or povidone-iodine nasal decolonization. Orthopedics 2014; 37 (06) e576-e581
    CrossrefPubMedGoogle Scholar
  • 52 Torres EG, Lindmair-Snell JM, Langan JW, Burnikel BG. Is preoperative nasal povidone-iodine as efficient and cost-effective as standard methicillin-resistant Staphylococcus aureus screening protocol in total joint arthroplasty?. J Arthroplasty 2016; 31 (01) 215-218
    CrossrefPubMedGoogle Scholar
  • 53 Bebko SP, Green DM, Awad SS. Effect of a preoperative decontamination protocol on surgical site infections in patients undergoing elective orthopedic surgery with hardware implantation. JAMA Surg 2015; 150 (05) 390-395
    CrossrefPubMedGoogle Scholar
  • 54 Rieser GR, Moskal JT. Cost efficacy of methicillin-resistant Staphylococcus aureus decolonization with intranasal povidone-iodine. J Arthroplasty 2018; 33 (06) 1652-1655
    CrossrefPubMedGoogle Scholar
  • 55 Urias DS, Varghese M, Simunich T, Morrissey S, Dumire R. Preoperative decolonization to reduce infections in urgent lower extremity repairs. Eur J Trauma Emerg Surg 2018; 44 (05) 787-793
    CrossrefPubMedGoogle Scholar
  • 56 Saidel L, Yosipovich R, Nativ R. et al. Semiquantitative Staphylococcus aureus nasal colony reduction in elective orthopedic surgery reduces surgical site infection. Infect Control Hosp Epidemiol 2020; 41: s386-s386
    CrossrefPubMedGoogle Scholar
  • 57 Peng HM, Wang LC, Zhai JL, Weng XS, Feng B, Wang W. Effectiveness of preoperative decolonization with nasal povidone iodine in Chinese patients undergoing elective orthopedic surgery: a prospective cross-sectional study. Braz J Med Biol Res 2017; 51 (02) e6736-e6736
    CrossrefPubMedGoogle Scholar
  • 58 Loftus RW, Dexter F, Goodheart MJ. et al. The effect of improving basic preventive measures in the perioperative arena on Staphylococcus aureus transmission and surgical site infections: a randomized clinical trial. JAMA Netw Open 2020; 3 (03) e201934-e201934
    CrossrefPubMedGoogle Scholar
  • 59 Kalmeijer MD, Coertjens H, van Nieuwland-Bollen PM. et al. Surgical site infections in orthopedic surgery: the effect of mupirocin nasal ointment in a double-blind, randomized, placebo-controlled study. Clin Infect Dis 2002; 35 (04) 353-358
    CrossrefPubMedGoogle Scholar
  • 60 Sankar B, Hopgood P, Bell KM. The role of MRSA screening in joint-replacement surgery. Int Orthop 2005; 29 (03) 160-163
    CrossrefPubMedGoogle Scholar
  • 61 Hacek DM, Robb WJ, Paule SM, Kudrna JC, Stamos VP, Peterson LR. Staphylococcus aureus nasal decolonization in joint replacement surgery reduces infection. Clin Orthop Relat Res 2008; 466 (06) 1349-1355
    CrossrefPubMedGoogle Scholar
  • 62 Hadley S, Immerman I, Hutzler L, Slover J, Bosco J. Staphylococcus aureus decolonization protocol decreases surgical site infections for total joint replacement. Arthritis (Egypt) 2010; 2010: 924518
    CrossrefPubMedGoogle Scholar
  • 63 Kim DH, Spencer M, Davidson SM. et al. Institutional prescreening for detection and eradication of methicillin-resistant Staphylococcus aureus in patients undergoing elective orthopaedic surgery. J Bone Joint Surg Am 2010; 92 (09) 1820-1826
    CrossrefPubMedGoogle Scholar
  • 64 Rao N, Cannella BA, Crossett LS, Yates Jr AJ, McGough III RL, Hamilton CW. Preoperative screening/decolonization for Staphylococcus aureus to prevent orthopedic surgical site infection: prospective cohort study with 2-year follow-up. J Arthroplasty 2011; 26 (08) 1501-1507
    CrossrefPubMedGoogle Scholar
  • 65 Baratz MD, Hallmark R, Odum SM, Springer BD. Twenty percent of patients may remain colonized with methicillin-resistant Staphylococcus aureus despite a decolonization protocol in patients undergoing elective total joint arthroplasty. Clin Orthop Relat Res 2015; 473 (07) 2283-2290
    CrossrefPubMedGoogle Scholar
  • 66 Sporer SM, Rogers T, Abella L. Methicillin-resistant and methicillin-sensitive Staphylococcus aureus screening and decolonization to reduce surgical site infection in elective total joint arthroplasty. J Arthroplasty 2016; 31 (9, Suppl): 144-147
    CrossrefPubMedGoogle Scholar
  • 67 Sousa RJG, Barreira PMB, Leite PTS, Santos AC, Ramos MH, Oliveira AF. Preoperative Staphylococcus aureus screening/decolonization protocol before total joint arthroplasty-results of a small prospective randomized trial. J Arthroplasty 2016; 31 (01) 234-239
    CrossrefPubMedGoogle Scholar
  • 68 Hofmann KJ, Hayden BL, Kong Q. et al. Triple prophylaxis for the prevention of surgical site infections in total joint arthroplasty. Curr Orthop Pract 2017; 28: 66-69
    CrossrefPubMedGoogle Scholar
  • 69 Stambough JB, Nam D, Warren DK. et al. Decreased hospital costs and surgical site infection incidence with a universal decolonization protocol in primary total joint arthroplasty. J Arthroplasty 2017; 32 (03) 728.e1-734.e1
    CrossrefPubMedGoogle Scholar
  • 70 Jeans E, Holleyman R, Tate D, Reed M, Malviya A. Methicillin sensitive staphylococcus aureus screening and decolonisation in elective hip and knee arthroplasty. J Infect 2018; 77 (05) 405-409
    CrossrefPubMedGoogle Scholar
  • 71 Pelfort X, Romero A, Brugués M, García A, Gil S, Marrón A. Reduction of periprosthetic Staphylococcus aureus infection by preoperative screening and decolonization of nasal carriers undergoing total knee arthroplasty. Acta Orthop Traumatol Turc 2019; 53 (06) 426-431
    CrossrefPubMedGoogle Scholar
  • 72 Rao N, Cannella B, Crossett LS, Yates Jr AJ, McGough III R. A preoperative decolonization protocol for staphylococcus aureus prevents orthopaedic infections. Clin Orthop Relat Res 2008; 466 (06) 1343-1348
    CrossrefPubMedGoogle Scholar
  • 73 Chen AF, Heyl AE, Xu PZ, Rao N, Klatt BA. Preoperative decolonization effective at reducing staphylococcal colonization in total joint arthroplasty patients. J Arthroplasty 2013; 28 (8, Suppl): 18-20
    CrossrefPubMedGoogle Scholar
  • 74 Moroski NM, Woolwine S, Schwarzkopf R. Is preoperative staphylococcal decolonization efficient in total joint arthroplasty. J Arthroplasty 2015; 30 (03) 444-446
    CrossrefPubMedGoogle Scholar
  • 75 Ghaddara HA, Kumar JA, Cadnum JL, Ng-Wong YK, Donskey CJ. Efficacy of a povidone iodine preparation in reducing nasal methicillin-resistant Staphylococcus aureus in colonized patients. Am J Infect Control 2020; 48 (04) 456-459
    CrossrefPubMedGoogle Scholar
  • 76 Pietrzak JRT, Maharaj Z, Mokete L. Prevalence of Staphylococcus aureus colonization in patients for total joint arthroplasty in South Africa. J Orthop Surg Res 2020; 15 (01) 123
    CrossrefPubMedGoogle Scholar
  • 77 Kurz A, Kurz M, Poeschl G, Faryniak B, Redl G, Hackl W. Forced-air warming maintains intraoperative normothermia better than circulating-water mattresses. Anesth Analg 1993; 77 (01) 89-95
    CrossrefPubMedGoogle Scholar
  • 78 Bennett J, Ramachandra V, Webster J, Carli F. Prevention of hypothermia during hip surgery: effect of passive compared with active skin surface warming. Br J Anaesth 1994; 73 (02) 180-183
    CrossrefPubMedGoogle Scholar
  • 79 Borms SF, Engelen SLE, Himpe DGA, Suy MR, Theunissen WJ. Bair hugger forced-air warming maintains normothermia more effectively than thermo-lite insulation. J Clin Anesth 1994; 6 (04) 303-307
    CrossrefPubMedGoogle Scholar
  • 80 Berti M, Casati A, Torri G, Aldegheri G, Lugani D, Fanelli G. Active warming, not passive heat retention, maintains normothermia during combined epidural-general anesthesia for hip and knee arthroplasty. J Clin Anesth 1997; 9 (06) 482-486
    CrossrefPubMedGoogle Scholar
  • 81 Casati A, Fanelli G, Ricci A. et al. Shortening the discharging time after total hip replacement under combined spinal/epidural anesthesia by actively warming the patient during surgery. Minerva Anestesiol 1999; 65 (7–8): 507-514
    PubMedGoogle Scholar
  • 82 Ng S-F, Oo C-S, Loh K-H, Lim PY, Chan YH, Ong BC. A comparative study of three warming interventions to determine the most effective in maintaining perioperative normothermia. Anesth Analg 2003; 96 (01) 171-176
    CrossrefPubMedGoogle Scholar
  • 83 Ng V, Lai A, Ho V. Comparison of forced-air warming and electric heating pad for maintenance of body temperature during total knee replacement. Anaesthesia 2006; 61 (11) 1100-1104
    CrossrefPubMedGoogle Scholar
  • 84 Trentman TL, Weinmeister KP, Hentz JG, Laney MB, Simula DV. Randomized non-inferiority trial of the vitalHEAT temperature management system vs the Bair Hugger warmer during total knee arthroplasty. Can J Anaesth 2009; 56 (12) 914-920
    CrossrefPubMedGoogle Scholar
  • 85 Brandt S, Oguz R, Hüttner H. et al. Resistive-polymer versus forced-air warming: comparable efficacy in orthopedic patients. Anesth Analg 2010; 110 (03) 834-838
    CrossrefPubMedGoogle Scholar
  • 86 McGovern PD, Albrecht M, Belani KG. et al. Forced-air warming and ultra-clean ventilation do not mix: an investigation of theatre ventilation, patient warming and joint replacement infection in orthopaedics. J Bone Joint Surg Br 2011; 93 (11) 1537-1544
    CrossrefPubMedGoogle Scholar
  • 87 Legg AJ, Cannon T, Hamer AJ. Do forced air patient-warming devices disrupt unidirectional downward airflow?. J Bone Joint Surg Br 2012; 94 (02) 254-256
    CrossrefPubMedGoogle Scholar
  • 88 Legg AJ, Hamer AJ. Forced-air patient warming blankets disrupt unidirectional airflow. Bone Joint J 2013; 95-B (03) 407-410
    CrossrefPubMedGoogle Scholar
  • 89 Kim HY, Lee KC, Lee MJ. et al. Comparison of the efficacy of a forced-air warming system and circulating-water mattress on core temperature and post-anesthesia shivering in elderly patients undergoing total knee arthroplasty under spinal anesthesia. Korean J Anesthesiol 2014; 66 (05) 352-357
    CrossrefPubMedGoogle Scholar
  • 90 Koc BB, Schotanus MGM, Kollenburg JAPAC, Janssen MJA, Tijssen F, Jansen EJP. Effectiveness of early warming with self-warming blankets on postoperative hypothermia in total hip and knee arthroplasty. Orthop Nurs 2017; 36 (05) 356-360
    CrossrefPubMedGoogle Scholar
  • 91 Oguz R, Diab-Elschahawi M, Berger J. et al. Airborne bacterial contamination during orthopedic surgery: a randomized controlled pilot trial. J Clin Anesth 2017; 38: 160-164
    CrossrefPubMedGoogle Scholar
  • 92 Sandoval MF, Mongan PD, Dayton MR, Hogan CA. Safety and efficacy of resistive polymer versus forced air warming in total joint surgery. Patient Saf Surg 2017; 11: 11
    CrossrefPubMedGoogle Scholar
  • 93 Tjoakarfa C, David V, Ko A, Hau R. Reflective blankets are as effective as forced air warmers in maintaining patient normothermia during hip and knee arthroplasty surgery. J Arthroplasty 2017; 32 (02) 624-627
    CrossrefPubMedGoogle Scholar
  • 94 Verra WC, Beekhuizen SR, van Kampen PM, de Jager MC, Deijkers RLM, Tordoir RL. Self-warming blanket versus forced-air warming in primary knee or hip replacement: a randomized controlled non-inferiority study. Asian J Anesthesiol 2018; 56 (04) 128-135
    PubMedGoogle Scholar
  • 95 McClain R, Bojaxhi E, Ford S, Hex K, Whalen J, Robards C. Forced-air convection versus underbody conduction warming strategies to maintain perioperative normothermia in patients undergoing total joint arthroplasty. Cureus 2020; 12 (11) e11474
    PubMedGoogle Scholar
  • 96 Schmied H, Kurz A, Sessler DI, Kozek S, Reiter A. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet 1996; 347 (8997): 289-292
    CrossrefPubMedGoogle Scholar
  • 97 Winkler M, Akça O, Birkenberg B. et al. Aggressive warming reduces blood loss during hip arthroplasty. Anesth Analg 2000; 91 (04) 978-984
    CrossrefPubMedGoogle Scholar
  • 98 Scott EM, Leaper DJ, Clark M, Kelly PJ. Effects of warming therapy on pressure ulcers–a randomized trial. AORN J 2001; 73 (05) 921-927 , 929–933, 936–938
    CrossrefPubMedGoogle Scholar
  • 99 Tumia N, Ashcroft GP. Convection warmers–a possible source of contamination in laminar airflow operating theatres?. J Hosp Infect 2002; 52 (03) 171-174
    CrossrefPubMedGoogle Scholar
  • 100 Moretti B, Larocca AMV, Napoli C. et al. Active warming systems to maintain perioperative normothermia in hip replacement surgery: a therapeutic aid or a vector of infection?. J Hosp Infect 2009; 73 (01) 58-63
    CrossrefPubMedGoogle Scholar
  • 101 Occhipinti LL, Hauptman JG, Greco JJ, Mehler SJ. Evaluation of bacterial contamination on surgical drapes following use of the Bair Hugger(®) forced air warming system. Can Vet J 2013; 54 (12) 1157-1159
    PubMedGoogle Scholar
  • 102 Fanelli A, Danelli G, Ghisi D, Ortu A, Moschini E, Fanelli G. The efficacy of a resistive heating under-patient blanket versus a forced-air warming system: a randomized controlled trial. Anesth Analg 2009; 108 (01) 199-201
    CrossrefPubMedGoogle Scholar
  • 103 Benson EE, McMillan DE, Ong B. The effects of active warming on patient temperature and pain after total knee arthroplasty. Am J Nurs 2012; 112 (05) 26-33 , quiz 34, 42
    CrossrefPubMedGoogle Scholar
  • 104 Charehbili A, Koek MBG, de Mol van Otterloo JCA. et al. Cluster-randomized crossover trial of chlorhexidine-alcohol versus iodine-alcohol for prevention of surgical-site infection (SKINFECT trial). BJS Open 2019; 3 (05) 617-622
    CrossrefPubMedGoogle Scholar
  • 105 Peel TN, Dowsey MM, Buising KL, Cheng AC, Choong PFM. Chlorhexidine-alcohol versus iodine-alcohol for surgical site skin preparation in an elective arthroplasty (ACAISA) study: a cluster randomized controlled trial. Clin Microbiol Infect 2019; 25 (10) 1239-1245
    CrossrefPubMedGoogle Scholar
  • 106 Carroll K, Dowsey M, Choong P, Peel T. Risk factors for superficial wound complications in hip and knee arthroplasty. Clin Microbiol Infect 2014; 20 (02) 130-135
    CrossrefPubMedGoogle Scholar
  • 107 Xu PZ, Fowler JR, Goitz RJ. Prospective randomized trial comparing the efficacy of surgical preparation solutions in hand surgery. Hand (N Y) 2017; 12 (03) 258-264
    CrossrefPubMedGoogle Scholar
  • 108 Gilliam DL, Nelson CL. Comparison of a one-step iodophor skin preparation versus traditional preparation in total joint surgery. Clin Orthop Relat Res 1990; (250) 258-260
    PubMedGoogle Scholar
  • 109 Ostrander RV, Botte MJ, Brage ME. Efficacy of surgical preparation solutions in foot and ankle surgery. J Bone Joint Surg Am 2005; 87 (05) 980-985
    CrossrefPubMedGoogle Scholar
  • 110 Saltzman MD, Nuber GW, Gryzlo SM, Marecek GS, Koh JL. Efficacy of surgical preparation solutions in shoulder surgery. J Bone Joint Surg Am 2009; 91 (08) 1949-1953
    CrossrefPubMedGoogle Scholar
  • 111 Grove GL, Eyberg CI. Comparison of two preoperative skin antiseptic preparations and resultant surgical incise drape adhesion to skin in healthy volunteers. J Bone Joint Surg Am 2012; 94 (13) 1187-1192
    CrossrefPubMedGoogle Scholar
  • 112 Gradl G, de Witte PB, Evans BT, Hornicek F, Raskin K, Ring D. Surgical site infection in orthopaedic oncology. J Bone Joint Surg Am 2014; 96 (03) 223-230
    CrossrefPubMedGoogle Scholar
  • 113 Grabsch EA, Mitchell DJ, Hooper J, Turnidge JD. In-use efficacy of a chlorhexidine in alcohol surgical rub: a comparative study. ANZ J Surg 2004; 74 (09) 769-772
    CrossrefPubMedGoogle Scholar
  • 114 Bibbo C, Patel DV, Gehrmann RM, Lin SS. Chlorhexidine provides superior skin decontamination in foot and ankle surgery: a prospective randomized study. Clin Orthop Relat Res 2005; 438 (438) 204-208
    CrossrefPubMedGoogle Scholar
  • 115 Cheng K, Robertson H, St Mart JP, Leanord A, McLeod I. Quantitative analysis of bacteria in forefoot surgery: a comparison of skin preparation techniques. Foot Ankle Int 2009; 30 (10) 992-997
    CrossrefPubMedGoogle Scholar
  • 116 Obamuyide H, Omololu A, Oluwatosin O. et al. Comparison of chlorhexidine-alcohol and providone iodine skin preparation skin preparation solutions in orthopaedic and trauma surgery at an African tertiary hospital. East Cent Afr J Surg 2015; 20: 80-87
    PubMedGoogle Scholar
  • 117 Su W-C, Lai Y-C, Lee C-H. et al. The prevention of periprosthetic joint infection in primary total hip arthroplasty using pre-operative chlorhexidine bathing. J Clin Med 2021; 10 (03) 434
    CrossrefPubMedGoogle Scholar
  • 118 Scheidt S, Walter S, Randau TM, Köpf US, Jordan MC, Hischebeth GTR. The influence of iodine-impregnated incision drapes on the bacterial contamination of scalpel blades in joint arthroplasty. J Arthroplasty 2020; 35 (09) 2595-2600
    CrossrefPubMedGoogle Scholar
  • 119 Hanada M, Hotta K, Furuhashi H, Matsuyama Y. Intraoperative bacterial contamination in total hip and knee arthroplasty is associated with operative duration and peeling of the iodine-containing drape from skin. Eur J Orthop Surg Traumatol 2020; 30 (05) 917-921
    CrossrefPubMedGoogle Scholar
  • 120 Rezapoor M, Tan TL, Maltenfort MG, Parvizi J. Incise draping reduces the rate of contamination of the surgical site during hip surgery: a prospective, randomized trial. J Arthroplasty 2018; 33 (06) 1891-1895
    CrossrefPubMedGoogle Scholar
  • 121 Webster J, Alghamdi A. Use of plastic adhesive drapes during surgery for preventing surgical site infection. Cochrane Database Syst Rev 2015; 2015 (04) CD006353
    PubMedGoogle Scholar
  • 122 Ritter MA, Campbell ED. Retrospective evaluation of an iodophor-incorporated antimicrobial plastic adhesive wound drape. Clin Orthop Relat Res 1988; (228) 307-308
    PubMedGoogle Scholar
  • 123 Milandt N, Nymark T, Jørn Kolmos H, Emmeluth C, Overgaard S. Iodine-impregnated incision drape and bacterial recolonization in simulated total knee arthroplasty. Acta Orthop 2016; 87 (04) 380-385
    CrossrefPubMedGoogle Scholar
  • 124 Kuo F-C, Tan TL, Wang J-W, Wang CJ, Ko JY, Lee MS. Use of antimicrobial-impregnated incise drapes to prevent periprosthetic joint infection in primary total joint arthroplasty: a retrospective analysis of 9774 cases. J Arthroplasty 2020; 35 (06) 1686-1691
    CrossrefPubMedGoogle Scholar
  • 125 Breitner S, Ruckdeschel G. Bacteriologic studies of the use of incision drapes in orthopedic operations [in German]. Unfallchirurgie 1986; 12 (06) 301-304
    PubMedGoogle Scholar
  • 126 Chiu KY, Lau SK, Fung B, Ng KH, Chow SP. Plastic adhesive drapes and wound infection after hip fracture surgery. Aust N Z J Surg 1993; 63 (10) 798-801
    CrossrefPubMedGoogle Scholar
  • 127 Blom AW, Barnett A, Ajitsaria P, Noel A, Estela CM. Resistance of disposable drapes to bacterial penetration. J Orthop Surg (Hong Kong) 2007; 15 (03) 267-269
    CrossrefPubMedGoogle Scholar
  • 128 Falk-Brynhildsen K, Friberg O, Söderquist B, Nilsson UG. Bacterial colonization of the skin following aseptic preoperative preparation and impact of the use of plastic adhesive drapes. Biol Res Nurs 2013; 15 (02) 242-248
    CrossrefPubMedGoogle Scholar
  • 129 French ML, Eitzen HE, Ritter MA. The plastic surgical adhesive drape: an evaluation of its efficacy as a microbial barrier. Ann Surg 1976; 184 (01) 46-50
    CrossrefPubMedGoogle Scholar
  • 130 Kuo F-C, Hsu C-W, Tan TL, Lin PY, Tu YK, Chen PC. Effectiveness of different wound dressings in the reduction of blisters and periprosthetic joint infection after total joint arthroplasty: a systematic review and network meta-analysis. J Arthroplasty 2021; 36 (07) 2612-2629
    CrossrefPubMedGoogle Scholar
  • 131 Tyagi V, Kahan J, Huang P, Li D, Gibson D. Negative pressure incisional therapy and postoperative infection after posterior approach primary total hip arthroplasty. Cureus 2020; 12 (03) e7394-e7394
    PubMedGoogle Scholar
  • 132 Tyagi V, Kahan J, Huang P, Leslie MP, Rubin LE, Gibson DH. Negative pressure incisional therapy and infection after direct anterior approach primary total hip arthroplasty. Orthopedics 2019; 42 (06) e539-e544
    CrossrefPubMedGoogle Scholar
  • 133 Curley AJ, Terhune EB, Velott AT, Argintar EH. Outcomes of prophylactic negative pressure wound therapy in knee arthroplasty. Orthopedics 2018; 41 (06) e837-e840
    CrossrefPubMedGoogle Scholar
  • 134 Higuera-Rueda CA, Emara AK, Nieves-Malloure Y. et al. The effectiveness of closed-incision negative-pressure therapy versus silver-impregnated dressings in mitigating surgical site complications in high-risk patients after revision knee arthroplasty: the PROMISES randomized controlled trial. J Arthroplasty 2021; 36 (7S): S295-302.e14
    CrossrefPubMedGoogle Scholar
  • 135 Karlakki SL, Hamad AK, Whittall C, Graham NM, Banerjee RD, Kuiper JH. Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties: a randomised controlled trial. Bone Joint Res 2016; 5 (08) 328-337
    CrossrefPubMedGoogle Scholar
  • 136 Giannini S, Mazzotti A, Luciani D. et al. Postoperative wound management with negative pressure wound therapy in knee and hip surgery: a randomised control trial. J Wound Care 2018; 27 (08) 520-525
    CrossrefPubMedGoogle Scholar
  • 137 Keeney JA, Cook JL, Clawson SW, Aggarwal A, Stannard JP. Incisional negative pressure wound therapy devices improve short-term wound complications, but not long-term infection rate following hip and knee arthroplasty. J Arthroplasty 2019; 34 (04) 723-728
    CrossrefPubMedGoogle Scholar
  • 138 Helito CP, Sobrado MF, Giglio PN. et al. The use of negative-pressure wound therapy after total knee arthroplasty is effective for reducing complications and the need for reintervention. BMC Musculoskelet Disord 2020; 21 (01) 490
    CrossrefPubMedGoogle Scholar
  • 139 Pachowsky M, Gusinde J, Klein A. et al. Negative pressure wound therapy to prevent seromas and treat surgical incisions after total hip arthroplasty. Int Orthop 2012; 36 (04) 719-722
    CrossrefPubMedGoogle Scholar
  • 140 Cooper HJ, Bas MA. Closed-incision negative-pressure therapy versus antimicrobial dressings after revision hip and knee surgery: a comparative study. J Arthroplasty 2016; 31 (05) 1047-1052
    CrossrefPubMedGoogle Scholar
  • 141 Manoharan V, Grant AL, Harris AC, Hazratwala K, Wilkinson MP, McEwen PJ. Closed incision negative pressure wound therapy vs conventional dry dressings after primary knee arthroplasty: a randomized controlled study. J Arthroplasty 2016; 31 (11) 2487-2494
    CrossrefPubMedGoogle Scholar
  • 142 Pauser J, Nordmeyer M, Biber R. et al. Incisional negative pressure wound therapy after hemiarthroplasty for femoral neck fractures - reduction of wound complications. Int Wound J 2016; 13 (05) 663-667
    CrossrefPubMedGoogle Scholar
  • 143 Anatone AJ, Shah RP, Jennings EL, Geller JA, Cooper HJ. A risk-stratification algorithm to reduce superficial surgical site complications in primary hip and knee arthroplasty. Arthroplast Today 2018; 4 (04) 493-498
    CrossrefPubMedGoogle Scholar
  • 144 Cooper HJ, Roc GC, Bas MA. et al. Closed incision negative pressure therapy decreases complications after periprosthetic fracture surgery around the hip and knee. Injury 2018; 49 (02) 386-391
    CrossrefPubMedGoogle Scholar
  • 145 Kim J-H, Kim H-J, Lee D-H. Comparison of the efficacy between closed incisional negative-pressure wound therapy and conventional wound management after total hip and knee arthroplasties: a systematic review and meta-analysis. J Arthroplasty 2019; 34 (11) 2804-2814
    CrossrefPubMedGoogle Scholar
  • 146 Urish KL, DeMuth PW, Kwan BW. et al. Antibiotic-tolerant Staphylococcus aureus biofilm persists on arthroplasty materials. Clin Orthop Relat Res 2016; 474 (07) 1649-1656
    CrossrefPubMedGoogle Scholar
  • 147 Li C, Renz N, Trampuz A. Management of periprosthetic joint infection. Hip Pelvis 2018; 30 (03) 138-146
    CrossrefPubMedGoogle Scholar
  • 148 Zmistowski B, Karam JA, Durinka JB, Casper DS, Parvizi J. Periprosthetic joint infection increases the risk of one-year mortality. J Bone Joint Surg Am 2013; 95 (24) 2177-2184
    CrossrefPubMedGoogle Scholar
  • 149 Scott RD. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Atlanta, GA: Centers for Disease Control and Prevention; 2009
    Google Scholar
  • 150 Kapadia BH, Berg RA, Daley JA, Fritz J, Bhave A, Mont MA. Periprosthetic joint infection. Lancet 2016; 387 (10016): 386-394
    CrossrefPubMedGoogle Scholar
  • 151 Lenguerrand E, Whitehouse MR, Beswick AD, Toms AD, Porter ML, Blom AW. National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. Description of the rates, trends and surgical burden associated with revision for prosthetic joint infection following primary and revision knee replacements in England and Wales: an analysis of the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. BMJ Open 2017; 7 (07) e014056-e014056
    CrossrefPubMedGoogle Scholar
  • 152 Sloan M, Premkumar A, Sheth NP. Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030. J Bone Joint Surg Am 2018; 100 (17) 1455-1460
    CrossrefPubMedGoogle Scholar
  • 153 Wolford HM, Hatfield KM, Paul P, Yi SH, Slayton RB. The projected burden of complex surgical site infections following hip and knee arthroplasties in adults in the United States, 2020 through 2030. Infect Control Hosp Epidemiol 2018; 39 (10) 1189-1195
    CrossrefPubMedGoogle Scholar
  • 154 Lum ZC, Natsuhara KM, Shelton TJ, Giordani M, Pereira GC, Meehan JP. Mortality during total knee periprosthetic joint infection. J Arthroplasty 2018; 33 (12) 3783-3788
    CrossrefPubMedGoogle Scholar
  • 155 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
    CrossrefPubMedGoogle Scholar
  • 156 Gow N, McGuinness C, Morris AJ, McLellan A, Morris JT, Roberts SA. Excess cost associated with primary hip and knee joint arthroplasty surgical site infections: a driver to support investment in quality improvement strategies to reduce infection rates. N Z Med J 2016; 129 (1432): 51-58
    PubMedGoogle Scholar
  • 157 Whitehouse JD, Friedman ND, Kirkland KB, Richardson WJ, Sexton DJ. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol 2002; 23 (04) 183-189
    CrossrefPubMedGoogle Scholar