Abstract
One of the most serious complications after total prosthetic arthroplasty is deep wound infection. The causes of the infection are considered as follows: contact infection, droplets infection, incompletely disinfected prosthesis, airy infection, and flora residents of skin and haematogenous infection. In order to prevent such postoperative infection, various prophylactic measures should be taken. Those which we have taken since 1971 at Tokushima University can be classified into three:
1) reinforcing basic sterile surgery, 2) administening antibiotics, and 3) performing surgery in a clean-air operating room.
The administration of antibiotics consists of systemic and local administration. Systemic administration means giving both 1 st generation cephem and 2nd and 3rd generation cephem or synthetic penicillin from the day before surgery to the day of the removal of the wound sutures. Local administration is carried out in two ways, by intraoperative wound irrigation with saline containing aminoglucoside, and by using Simplex-p bone cement mixed with cephaloridine (2 g per 40 g pack of polymer) or dibekacin sulfate (1 g per 40 g pack of polymer) .
The clean-air operating room which we have used since 1974 is a horizontal laminar-air-flow system of the hard wall type with 300 air changes an hour.
Under these prophylactic measures, 368 total prosthetic replacements (total hip replacement, 293; total knee replacement; 70; and others; 5) have been performed. Postoperative deep wound infections have occurred in 3 cases, all of which were late infections. In the 1st case, a 63-year-old woman with RA, a late deep infection occurred 8 years after total knee replacement. Staphylococcus aureus was isolated from the wound. In the 2nd case, a 55-year-old man with chondrosarcoma of the left whole humerus, was recognized to have inflammatory signs on the elbow region 1.5 years after total humerus and elbow replacement. But microogamsms were not isolated from the wound. In the 3rd case, a 57-year-old woman with latent tuberculous gonitis, tuberculous arthritis reoccurred 1.5 years after total knee replacement.
