Laminar air flow may not reduce incidence of PJI following primary TJA
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Use of laminar air flow for OR ventilation is not associated with reduced incidence of periprosthetic joint infection following total hip and knee arthroplasties, according to recently presented results.
“The prevention of PJI following joint arthroplasty is vitally important,” said Samuel Clarkson, MD, who presented findings of his retrospective observational study on laminar airflow (LAF) and periprosthetic joint infection (PJI) at the Musculoskeletal Infection Society Annual Meeting. The meeting was held virtually.
“PJI remains a significant problem following primary TJA, with infection being a common cause of failure after both hip and knee arthroplasty,” Clarkson said in the presentation. “In addition to effects on morbidity and mortality to the patient, the economic burden continues to rise. A 2012 estimate demonstrated an expected overall economic burden of PJI in the United States at $1.6 billion,” he said.
From January 2013 to September 2017, Clarkson and colleagues at the Rothman Orthopaedic Institute analyzed the effects of LAF in a cohort of 6, 972 patients (4,175 patients who underwent THA and 2,797 patients who underwent TKA) with a minimum 1-year follow-up.
“Ambient air in the OR is believed to be a route of microbial entry and one factor that contributes to PJI,” Clarkson said. “Therefore, one strategy to prevent infection is through strict control of the OR environment through the ventilation system,” he added.
Clarkson and colleagues randomly assigned patients to undergo TJA at either center A, an LAF-equipped OR, or center B, a conventionally equipped OR.
“In [the] overall cohort, we saw a 1-year PJI rate of 0.49% (33/6,972 patients). Twenty-one cases were seen at the site with LAF compared to 12 cases at the site with the conventional system,” he said. “In all of our analyses, including multivariate regression and propensity-score matching, there was no significant increase or decrease in the risk of PJI,” Clarkson added.
Clarkson concluded that LAF is not necessary for prevention of PJI in patients undergoing primary TJA, but there might be some explanation for the lack of evidence despite the theoretical advantages of LAF.
“Parallel airflow in such a system is easily disrupted by objects and personnel around the surgical field,” he said. “Adherence to strict protocol is not always followed, including the correct positioning of the instrument table under the LAF canopy,” he added.
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Clarkson S, et al. Presentation 29. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 7-8, 2020 (virtual meeting).
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