Risk factors for superficial wound complications in hip and knee arthroplasty

Authors

  • K. Carroll,

    1. Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
    Search for more papers by this author
  • M. Dowsey,

    1. Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
    2. Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
    Search for more papers by this author
  • P. Choong,

    1. Department of Orthopaedics, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
    2. Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
    Search for more papers by this author
  • T. Peel

    Corresponding author
    1. Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
    2. Department of Infectious Diseases, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
    • Corresponding author: Dr T. Peel, St Vincent's Hospital Melbourne, Department of Orthopaedics, 3rd Floor, Daly Wing, PO Box 2900, Fitzroy, Victoria 3065, Australia

      E-mail: tnpeel@unimelb.edu.au

    Search for more papers by this author

Abstract

Superficial wound complications have been consistently implicated in the development of prosthetic joint infection. This cohort study aimed to determine perioperative risk factors associated with superficial wound complications. The study was performed over an 18-month period (January 2011 to June 2012) and included 964 patients undergoing prosthetic hip or knee replacement surgery. The factors associated with superficial wound complication differed according to arthroplasty site. In the combined cohort the following factors were associated with superficial wound complications: the use of 0.5% chlorhexidine in 70% alcohol for surgical skin preparation compared with 1% iodine in 70% alcohol (odds ratio (OR) 4.75; 95% confidence interval (CI) 1.42, 15.92; p = 0.012); increasing age (OR, 1.13; 95% CI, 1.06,1.19; p 0.18); increasing body mass index (BMI) (OR, 1.08; 95% CI, 1.05,1.12; p < 0.001); rheumatoid arthritis (OR, 2.56; 95% CI, 1.17, 5.58; p 0.018); and increasing blood transfusions (OR, 1.26; 95% CI, 1.06,1.49; p 0.008). In the hip arthroplasty cohort, the use of 0.5% chlorhexidine in 70% alcohol for surgical skin preparation (OR, 13.35; 95% CI, 2.11, 84.29; p 0.006), increasing BMI (OR, 1.13; 95% CI, 1.06, 1.19; p < 0.001) and increasing blood transfusions (OR, 1.26; 95% CI, 1.06, 1.49; p 0.008) were associated with superficial wound complications. In the knee arthroplasty cohort rheumatoid arthritis (OR, 2.75; 95% CI, 1.03, 7.33; p 0.043) and increasing tourniquet time (OR, 1.01; 95% CI, 1.00, 1.02; p = 0.029) were independent predictors of superficial wound complications. Further research is warranted to assess the impact of modification of these factors on the subsequent development of wound complications and prosthetic joint infection.

Ancillary