Is arthroplasty immediately after an infected case a risk factor for infection?

BACKGROUND: It is common practice in many centers to avoid performing a clean case in a room in which an infected procedure has just taken place. No studies of which we are aware speak to the necessity of this precaution. QUESTIONS/PURPOSES: The purposes of this study were to identify (1) the risk of infection in a group of patients who underwent arthroplasties performed immediately after a first-stage arthroplasty for joint infection; and (2) the risk of superficial and deep infections in these patients compared with a matched group of patients who underwent arthroplasties not performed after an infected surgery. METHODS: Eighty-three patients (85 arthroplasties) who underwent arthroplasties (primary or revision) immediately after patients with known infections underwent surgery in the same operating room (OR) were analyzed for 12 months after surgery to determine the incidence of infection. They were matched for demographic factors and surgery type with a control group of 321 patients (354 arthroplasties) who underwent surgery in an OR that had not just been used for surgery involving patients with infections. We compared the risk of superficial and deep infections between the groups. RESULTS: Patients in the study group were not more likely to have infections develop than those in the control group. One patient in the study group (1.17%) and three in the control group (0.84%) had deep infections develop; the infection in the patient in the study group was caused by a different organism than that of the patient with an infection whose surgery preceded in the OR. Two superficial infections (2.35%) were detected in the study group and 17 (4.8%) were detected in the control group. CONCLUSIONS: With the numbers available, we found that a deep infection was not more likely to occur in a patient without an infection after an arthroplasty that followed surgery on a patient with an infection than in one who had surgery after a clean case. Although sample size was a potential issue in this study, the results may serve as hypothesis generating for future studies. LEVEL OF EVIDENCE: Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Secondary Hip Osteoarthritis due to Neurofibroma Treated with Total Hip Replacement.

Background. Local plexiform neurofibroma can lead to deformity of the pelvis, valgus deformity of femoral neck, and joint capsule laxity. We report a case of secondary hip osteoarthritis with subluxation and coxa vara deformity resulting from an extra-articular neurofibroma treated with total hip replacement. Case Description. A 39-year-old man had a large benign plexiform neurofibroma at buttock which induced secondary osteoarthritis of the hip. Conservative treatment of tumor was selected because the patient had low chance of malignant transformation due to absence of other neurofibromatosis features. However, due to secondary osteoarthritis he underwent total hip arthroplasty. Anterior capsulotomy was selected to avoid large posterior hip tumor mass. In order to avoid the difficulties associated with setting tension of the abductor muscle, modified trochanteric slide osteotomy with trochanteric advancement, lateralized cup placement, and extended neck offset were used. One year after the surgery, the patient had excellent clinical function, hip stability, leg length equality and was satisfied with the outcome. Clinical Relevance. We concluded that the modified trochanteric slide osteotomy with trochanteric advancement represents a valuable approach for THR in patients with extremely elongation of the hip abductor and secondary hip osteoarthritis resulting from extra-articular neurofibroma.