Prevention of infection in primary THA and TKA

Overview

This 2020 instructional lecture in EFORT Open Reviews by Dobson and Reed reviews current strategies to reduce surgical site infection and periprosthetic joint infection after primary total hip and knee arthroplasty. It treats infection prevention as a multi-faceted effort that combines patient-related and surgical measures, rather than any single intervention.

Who it is for

Arthroplasty surgeons, anaesthetists, theatre teams, infection prevention staff and residents involved in planning and delivering elective hip and knee replacement.

Key areas covered

The authors describe how patient factors such as age, body mass, co-morbidities and lifestyle interact with surgical factors to shape infection risk. Measures discussed include pre-operative bacterial decolonisation, screening for and correcting anaemia, maintaining normal body temperature around surgery, skin antisepsis, antiseptic wound lavage and antibacterial-coated sutures. The article places these tactics in historical context, from Lister's antiseptic principle to modern prophylaxis.

Notable emphasis

Beyond established measures, the lecture looks at newer questions: whether the choice of bearing surface influences infection risk, and ongoing debates about blood transfusion, laminar airflow and protective surgical hoods and suits. It presents these as areas where evidence is still evolving rather than settled practice.

How to use this guideline

The article is a focused overview of recent tactics, not an exhaustive protocol. Readers should consult the full text for the evidence behind each measure and align implementation with national guidance and local infection control policy.