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Infection in primary total knee replacement
Jason CH Fan,
HH Hung,
KY Fung
Department of Orthopaedics and
Traumatology, Alice Ho Miu Ling
Nethersole Hospital, Tai Po, Hong Kong
OBJECTIVES. To determine the infection rate and identify the risk factors of
primary total knee replacement in a general hospital and discuss
possible preventive measure.
DESIGN. Retrospective study.
SETTING. Regional hospital, Hong Kong.
PATIENTS. All cases of primary total knee replacement performed between
the period July 1997 and June 2006 were reviewed.
MAIN OUTCOME MEASURES. Infection rate of primary total knee replacement and its
relationship to risk factors.
RESULTS. In the defined period, 479 total knee replacements were
performed in 353 patients (291 female and 62 male); 105 women
and 21 men had bilateral replacements. The mean patient age
was 69 (range, 40-88) years. In all, 447 knees had osteoarthritis,
and 32 had rheumatoid arthritis. The mean follow-up period was
46 (range, 1-107) months; 345 knees were followed up longer
than 24 months, but seven had no postoperative follow-up.
Wound infection was defined by clinical, bacteriological, and/or histological examination. Primary total knee replacement
was invariably performed in a theatre with vertical laminar flow,
under prophylactic antibiotic cover, and body exhaust suits,
water impermeable gowns, and double gloves were always used.
The overall infection rate was 3.0% (14/472); the acute deep
infection rate (within 4 weeks) was 0.2% (1/472), the delayed deep
infection rate (4 weeks-2 years) was 0.6% (2/345). The superficial
infection rate was 1.9% (9/472) and the late deep infection rate
(after 2 years) was 0.6% (2/345). Diabetic patients had a threefold
higher risk of infection than non-diabetic patients, though
this difference did not attain statistical significance (P=0.077).
CONCLUSIONS. Our infection rates for primary total knee replacement were
comparable to those encountered internationally.
Hong Kong Med J 2008;14:40-5
Key words: Arthroplasty, replacement, knee;
Infection
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