Preventing Deep Infection in Total Knee Replacement

Abstract

BACKGROUND: The rate of infection following primary total knee replacement (TKR) ranges between 1 and 2%. The medical community has implemented many practices with the intention of preventing infection after TKR. QUESTION: What are the prevention measures to reduce infection risk after TKR? METHODS: A PubMed (MEDLINE) search and a Cochrane Library search were performed until 31 March 2014. Six hundred and fifty-seven articles were found but only 42 were finally analysed. The main criteria for selection were that the articles addressed the aforementioned question. RESULTS: Rheumatoid arthritis, diabetes mellitus, immunosuppression treatment, psoriasis, and previous infections in the knee are the risk factors most clearly related with TKR infection. Appropriate patient selection is fundamental. Staphylococcus Aureus is the most common organism in infected TKRs. Systematic preoperative screening by swab is very important. Prevention of MRSA-positive cases by means of nasal decontamination (mupirocin 3 days) is advisable. Preoperative antibiotic prophylaxis has shown to be an efficient method to lower infection rates. Appropriate surgeon´s preparation and clean air in the operating room (OR) also seem to be important. Many authors have used ORs equipped with laminar air flow (LAF) although some authors have recently found that the incidence of infection decreased after abandoning the LAF in ORs. Adequate skin preparation and dressings also appear to be very important. Prolonged operative time seems to correlate with increased infection rate after TKR. The correlation between antibiotic-loaded cement and the risk of infection is still controversial. CONCLUSIONS: Prevention measures could help diminish the infection rate in patients undergoing TKR but the efficacy of some preventive practices is still controversial.