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Comparative Study
. 2016 Aug;31(8):1746-9.
doi: 10.1016/j.arth.2016.02.004. Epub 2016 Feb 9.

Risk of Contamination in Assembled vs Disassembled Instruments in Hip Arthroplasty Surgery

Ryan R Mayer  1 , S Samuel Bederman  2 , Vincent M Colin  1 , Martina M Berger  3 , Thomas C Cesario  3 , Ran Schwarzkopf  4
Affiliations
Comparative Study

Risk of Contamination in Assembled vs Disassembled Instruments in Hip Arthroplasty Surgery

Ryan R Mayer et al. J Arthroplasty. 2016 Aug.

Abstract

Background: Periprosthetic joint infection (PJI) is one of the most common causes of revision total hip arthroplasty (THA) and associated with higher costs, prolonged pain, and worse clinical outcomes. Many factors have been linked to increased infection rates, one being the operative equipment and instrumentation used during the surgical procedure. With few arthroplasty instruments designed for complete disassembly and increasingly complex instrument designs, this study seeks to understand the effect that instrument disassembly plays on infection using disassembled and assembled standard femoral broach handles (BHs).

Methods: Two BHs, not designed for disassembly, were modified and then contaminated in the disassembled state with Geobacillus stearothermophilus vegetative-form bacteria and spores. Using both flash and standard sterilization cycles, the BHs were steam sterilized in the disassembled or assembled state and then analyzed for remaining bacteria and spores.

Results: At all target locations after either a flash sterilization cycle or a standard sterilization cycle, complete eradication of both the vegetative-form and spore-form of G stearothermophilus was achieved.

Conclusion: This study demonstrates that adequate decontamination of the tested BHs can be achieved after steam sterilization in either the disassembled or assembled state, without an increased risk of infection transmission.

Keywords: contamination; disassembled; instrumentation; periprosthetic joint infection; sterility; total hip arthroplasty.

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Conflict of interest statement

One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2016.02.004.

Figures

Fig. 1
Fig. 1
Standard femoral broach handle in assembled state. Note the screws (asterisk), which replaced the original pins so that the instrument could be disassembled.
Fig. 2
Fig. 2
Standard femoral broach handle in a disassembled state with the 5 tested locations labeled (red asterisk = test sites; black asterisk = control).
Fig. 3
Fig. 3
Protocol used for the inoculation and sterilization of the broach handles.
See this image and copyright information in PMC

References

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