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Prevention of Surgical Site Infection in Total Joint Arthroplasty: An International Tertiary Care Center Survey

HSS Journal: Volume 10, Issue 1



Prevention strategies are critical to reduce infection rates in total joint arthroplasty (TJA), but evidence-based consensus guidelines on prevention of surgical site infection (SSI) remain heterogeneous and do not necessarily represent this particular patient population.


What infection prevention measures are recommended by consensus evidence-based guidelines for prevention of periprosthetic joint infection? How do these recommendations compare to expert consensus on infection prevention strategies from orthopedic surgeons from the largest international tertiary referral centers for TJA?

Patients and Methods

A review of consensus guidelines was undertaken as described by Merollini et al. Four clinical guidelines met inclusion criteria: Centers for Disease Control and Prevention's, British Orthopedic Association, National Institute of Clinical Excellence's, and National Health and Medical Research Council's (NHMRC). Twenty-eight recommendations from these guidelines were used to create an evidence-based survey of infection prevention strategies that was administered to 28 orthopedic surgeons from members of the International Society of Orthopedic Centers. The results between existing consensus guidelines and expert opinion were then compared.


Recommended strategies in the guidelines such as prophylactic antibiotics, preoperative skin preparation of patients and staff, and sterile surgical attire were considered critically or significantly important by the surveyed surgeons. Additional strategies such as ultraclean air/laminar flow, antibiotic cement, wound irrigation, and preoperative blood glucose control were also considered highly important by surveyed surgeons, but were not recommended or not uniformly addressed in existing guidelines on SSI prevention.


Current evidence-based guidelines are incomplete and evidence should be updated specifically to address patient needs undergoing TJA.

Level of Evidence: Level I: (Guidelines) and Level V Survey (Expert Consensus). See the Guidelines for Authors for a complete description of levels of evidence.

This article appears in HSS Journal: Volume 10, Issue 1.
View the full article at springerlink.com.

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.


Benjamin F. Ricciardi, MD

Department of Orthopedic Surgery, Hospital for Special Surgery

Headshot of Mathias P. Bostrom, MD
Mathias P. Bostrom, MD
Chief of Hip Service, Hospital for Special Surgery
Attending Orthopedic Surgeon, Hospital for Special Surgery

Lars Lidgren, MD

Department of Orthopedics Clinical Sciences Lund, Lund University
The Swedish Knee Arthroplasty Register, Lund

Jonas Ranstam, MD

National Musculoskeletal Competence Centre, Lund

Katharina M. D. Merollini, PhD

Institute of Heath and Biomedical Innovation, Queensland University of Technology

Annette W-Dahl, PhD

The Swedish Knee Arthroplasty Register, Lund


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