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Relationship Between Clean Hand Surgery and Periprosthetic Joint Infection (PJI): A Retrospective Analysis
Doger Norceide, MS
1, Abdullah Mahmood, BS
1, Jeremiah A. Adams, BS
2, Sina Ramtin, MD
2, Anthony Castro, BA
2, Chris Sun, BA
2; Asif M. Ilyas, MD, MBA
1,2(1)Drexel University College of Medicine, Philadelphia, PA, (2)Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
Background: Periprosthetic Joint Infection (PJI) is a serious and costly complication following total joint arthroplasty, often necessitating prolonged revision surgery, prolonged antibiotic therapy, profound disability, substantial healthcare costs, and a meaningful risk of mortality. While PJI has been extensively studied, less is known about the risk of hematogenous seeding from remote surgical procedures, such as clean hand surgeries, in patients with existing joint implants. Prior studies report a low incidence of PJI ranging from 0.2% to 0.8% within 12 months following clean hand surgery in patients with prior arthroplasty, though evidence is limited and at times conflicting. The objective of this study was to determine the incidence and clinical characteristics of periprosthetic joint infection in patients with total joint arthroplasties who subsequently underwent clean elective hand surgery.
Methods: A retrospective review of patients at a large academic orthopedic practice from 2015 to 2023 was performed, and all patients who underwent total knee, hip, ankle, shoulder, and elbow arthroplasty were defined as the arthroplasty cohort. Among this cohort, patients who underwent any elective clean hand surgery after a prior arthroplasty were queried to develop the study cohort, which was subsequently analyzed through a detailed chart review to determine if any reoperations occurred within 1 year of the clean hand surgery that was defined as a PJI.
Results: A total of 971 patients with prior total joint arthroplasty who underwent clean elective hand surgery were identified as the study cohort. Of these, 91 patients (9.4%) were initially flagged for undergoing an additional surgery after the index clean hand surgery. Following detailed chart review, 6 patients (0.6%) were confirmed to have undergone reoperation for PJI within 12 months of the clean hand surgery. However, in no case was the cause of the PJI determined to be the hand surgery.
Discussion/Conclusion: The study findings suggest a continued low incidence of PJI (0.6%) after elective clean hand surgery. However, the clinical relationship between the hand surgery and the ultimate PJI remains in question without a clear correlation. These study findings do not point to the need for routine PJI prophylaxis but do indicate the need for continued research on this topic.
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