Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.
Clin Orthop Surg. 2020 Mar;12(1):43-48. doi: 10.4055/cios.2020.12.1.43. Epub 2020 Feb 13.
Periprosthetic joint infection (PJI) is one of the commonly found catastrophic complications after total knee arthroplasty (TKA). Preoperative antibiotic prophylaxis, proper skin cleansing, shortened operative time, and sterility of surgical field and equipment are essential to minimize the risk of PJI. Although bacterial contamination of electrocautery tips has been reported, contamination of residual product of electrocoagulation, burnt necrotic tissue (BNT), is not well known. Therefore, we aimed to assess the contamination rate of BNT and association between contaminated BNT and PJI, and risk factors.
BNTs from 183 patients who had undergone unilateral primary TKA at our institution were retrospectively analyzed. In each patient, three to five specimens of BNT were routinely collected in the operative field of primary TKA. Collecting time was defined as the duration from start of using the electrocautery device to the first collection of BNT.
Culture was positive in eight of 183 patients (4.4%; contaminated BNT group), and the most commonly isolated organism was coagulase-negative (62.5%). The average operative time was 103.1 ± 44.2 minutes in the contaminated BNT group and 79.0 ± 16.7 minutes in the non-contaminated BNT group ( = 0.17), and collecting time was 48.0 ± 44.3 minutes and 29.7 ± 17.0 minutes ( = 0.28), respectively. None of the patients with contaminated BNT developed PJI, whereas four patients with culture-negative BNT developed PJI within 2 postoperative years.
BNT in surgical field can become a reservoir of contaminating bacteria. However, contamination of BNT was not associated with PJI. Therefore, routine removal of all BNTs may be unnecessary.
假体周围关节感染（PJI）是全膝关节置换术（TKA）后常见的灾难性并发症之一。术前抗生素预防、适当的皮肤清洁、缩短手术时间以及手术区域和设备的无菌性是降低 PJI 风险的关键。虽然已经报道了电外科器械尖端的细菌污染，但电凝残留产物、烧焦的坏死组织（BNT）的污染情况并不为人所知。因此，我们旨在评估 BNT 的污染率以及污染的 BNT 与 PJI 之间的关联，并确定相关的危险因素。
回顾性分析了在我院接受单侧初次 TKA 的 183 例患者的 BNT。在每位患者中，常规收集初次 TKA 手术野中的 3 至 5 份 BNT 标本。采集时间定义为使用电外科器械开始到首次采集 BNT 的时间。
183 例患者中有 8 例（4.4%；污染的 BNT 组）培养阳性，最常见的分离菌为凝固酶阴性菌（62.5%）。污染的 BNT 组的平均手术时间为 103.1±44.2 分钟，非污染的 BNT 组为 79.0±16.7 分钟（ = 0.17），采集时间分别为 48.0±44.3 分钟和 29.7±17.0 分钟（ = 0.28）。污染的 BNT 组中无患者发生 PJI，而培养阴性的 BNT 组中有 4 例患者在术后 2 年内发生 PJI。
手术野中的 BNT 可能成为污染细菌的储存库。然而，BNT 的污染与 PJI 无关。因此，常规清除所有 BNT 可能是不必要的。
