Screw augmented cement spacer for deficient acetabulum in periprosthetic infection following Total Hip Arthroplasty

Does a sign restricting operating room access reduce staff traffic in the surgical department?

INTRODUCTION

Infections following orthopedic surgery are rare but difficult to treat. Among the prevention measures reviewed during the Musculoskeletal Infection Society's (MSIS) 2023 international consensus meeting, the only strategy to obtain 100% agreement was the control of traffic in and out of the operating room (OR). Although this recommendation makes good sense, to our knowledge, it has not been previously investigated in a comparative study. We, therefore, conducted a prospective, observational, before-and-after study of the implementation of an informational sign designed to limit traffic in and out of the OR to (1) determine its impact on door openings and the number of people present during orthopedic surgery and (2) assess the risk of surgical site infection after the institution of this sign.

HYPOTHESIS

This type of sign reduces the number of door openings.

MATERIALS AND METHODS

This prospective, observational study included all patients operated on in one of our ORs over a 6-week period. The number of entrances and exits from the OR and how long the doors were kept open were recorded during the entire study period. After 3 weeks, an informational sign was posted on the OR doors warning people that unnecessary traffic in and out of the OR increases the risk of infection. During this period, we also recorded the type of procedure, operative time, the number of people in the OR at the time of the incision, and the number of entrances and exits. Patients underwent a follow-up at 2 years to check for postoperative infection. The primary endpoint was the number of OR door openings, and the secondary endpoint was the number of infections at 2 years postoperatively.

RESULTS

The 2 groups (before and after the implementation of the sign) were homogeneous. The average total number of door openings for all ORs was 28.9±19.6 [2-90]. In the no sign group, it was 33.3±20.9 [3-90], and in the sign group, it was 21.0±14.7 [2-50] (p=0.011). The maximum number of people in the OR at one time was 8.32±1.84 [4-12] in the no sign group and 8.44±1.98 [5-12] in the sign group (p=0.8). There were 3 postoperative infections at the 2-year follow-up, all occurring in the no sign group. The infection rate was 6.4% (3/47) in the no sign group versus 0% (0/25) in the sign group (p=0.197).

DISCUSSION

Our prospective study demonstrated a simple strategy to reduce the number of entrances and exits, the number of people in the OR, and potentially the risk of surgery-related infection. Another larger-scale study is needed to assess the exact impact of this type of sign, particularly on the risk of infection.

LEVEL OF EVIDENCE

III; prospective non-randomized comparative study.

Articulating spacers: what are available and how to utilize them?

Periprosthetic joint infection (PJI) is the most devastating complication following total joint arthroplasty (TJA) and is posing a global healthcare challenge as the demand for TJA mounts. Two-stage exchange arthroplasty with the placement of antibiotic-loaded spacers has been shown to be efficacious against chronic PJI. This study aimed to review the key concepts, types, and outcome evaluations of articulating spacers in the two-stage exchange for PJI. Previous studies indicated that articulating spacers have been widely used due to better functional improvement and a comparable infection control rate relative to static spacers. Several types of articulating spacers are reportedly available, including hand-made spacers, spacers fashioned from molds, commercially preformed spacers, spacers with additional metal or polyethylene elements, new or autoclaved prosthesis, custom-made articulating spacers, and 3D printing-assisted spacers. However, limited evidence suggested no significant difference in clinical outcomes among the different subtypes of articulating spacers. Surgeons should be familiar with different treatment strategies when using various spacers to know which is the most appropriate.