Preventing surgical site infection in haemophilia patients undergoing total knee arthroplasty.

UNLABELLED

The rate of infection following primary total knee arthroplasty (TKA) in the general population is 1% on average. However, in persons with haemophilia (PWH), the mean rate of infection following primary TKA is nearly 8%.

QUESTIONS

why is the infection rate higher in persons with haemophilia compared with the general population? what should be done to correct this? A PubMed (MEDLINE) search and a Cochrane Library search were performed. The most important articles as judged by the author were selected for this review. The main criteria for selection were that the articles addressed the prevention of infection in PWH undergoing TKA. Patient-related risk factors predisposing to postoperative infection in the general population include immunodepression and previous infection in the knee. Methicillin-resistant Staphylococcus aureus (MRSA) is the most common organism in infected TKAs. 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 itself to be an efficient method to lower infection rates. Operating theatres ideally should be equipped with laminar flow. In PWH, there are three additional risk factors: insufficient haemostasis, HIV-positive status, and central venous catheters (CVCs). Implementing the preventive measures for the general population and a sufficient level of clotting factor for 2-3 weeks can help diminish the infection in PWH undergoing TKA. In HIV-positive patients with CD4 count less than 200 cells/μl , early, vigorous treatment should be instituted for suspected infection and surgical intervention individualized based on the balance of risks and benefits. Strict adherence to handwashing and aseptic technique are essential elements of catheter care. Caregiver education is an integral part of CVC use and the procedural practices of users should be regularly reassessed. If TKA is contraindicated, arthroscopic knee joint debridement can relieve pain for several years and delay the need for TKA.