The incidence of deep prosthetic infections in a specialist orthopaedic hospital

TLDR

The Control of Infection Committee prospectively recorded all bacteriologically‑proven deep infections after primary hip and knee replacements over 15 years in 10,735 patients. Deep infection occurred in 0.57% of hip and 0.86% of knee replacements, with coagulase‑negative staphylococcus most common, 72% of organisms antibiotic‑sensitive, 96% of infections eradicated, and only 64% arising within one year, highlighting the advantage of specialist hospital care.

Abstract

The Control of Infection Committee at a specialist orthopaedic hospital prospectively collected data on all episodes of bacteriologically-proven deep infection arising after primary hip and knee replacements over a 15-year period from 1987 to 2001. There were 10 735 patients who underwent primary hip or knee replacement. In 34 of 5947 hip replacements (0.57%) and 41 of 4788 knee replacements (0.86%) a deep infection developed. The most common infecting micro-organism was coagulase-negative staphylococcus, followed by Staphylococcus aureus, enterococci and streptococci. Of the infecting organisms, 72% were sensitive to routine prophylactic antimicrobial agents. Of the infections, 29% (22) arose in the first three months following surgery, 35% between three months and one year (26), and 36% (27) after one year. Most cases were detected early and treated aggressively, with eradication of the infection in 96% (72). There was no significant change in the infection rate or type of infecting micro-organism over the course of this study. These results set a benchmark, and importantly emphasise that only 64% of peri-prosthetic infections arise within one year of surgery. These results also illustrate the advantages of conducting joint replacement surgery in the isolation of a specialist hospital.