The Prevention of Periprosthetic Joint Infection in Primary Total Hip Arthroplasty Using Pre-Operative Chlorhexidine Bathing.

Wen-Chi Su,Yu-Chin Lai,Cheng-Min Shih,Chao-Ping Chen,Shun-Ping Wang,Cheng-Hung Lee,Li-Ling Hung

doi:10.3390/jcm10030434

Abstract

Periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is a devastating complication. The aim of this study was to investigate whether preoperative bathing using chlorhexidine gluconate (CHG) before THA can effectively reduce the postoperative PJI rate. A total of 933 primary THA patients, with the majority being female (54.4%) were included in the study. Primary THA patients who performed preoperative chlorhexidine bathing were assigned to the CHG group (190 subjects), and those who did not have preoperative chlorhexidine bathing were in the control group (743 subjects). The effects of chlorhexidine bathing on the prevention of PJI incidence rates were investigated. Differences in age, sex, and the operated side between the two groups were not statistically significant. Postoperative PJI occurred in four subjects, indicating an infection rate of 0.43% (4/933). All four infected subjects belonged to the control group. Although the PJI cases were significantly more in the control group than in the CHG group, statistical analysis revealed no statistical significance in the risk of PJI occurrence between the two groups (p = 0.588). Preoperative skin preparation by bathing with a 2% chlorhexidine gluconate cleanser did not produce significant effects on the prevention of postoperative PJI in primary THA.

Highlights

Of the 743 control subjects, four developed periprosthetic joint infection (PJI), indicating a PJI incidence rate of 0.54% in the control group. This incidence rate was significantly higher in the control group than that of the chlorhexidine gluconate (CHG) group (0%), there was no significant statistical difference in the risk of PJI between the two groups. Such a result is in agreement with certain studies that have indicated the lack of conclusive evidence that chlorhexidine bathing reduces the risk of surgical site infection (SSI) [27,29] but is inconsistent with the results reported by Kapadia et al, who demonstrated that cleansing with 2% chlorhexidine cloth the night before and on the morning of surgery, reduced the risk of SSI in total joint replacement (TJR) patients [20,25,32]
Kapadia et al reported that wiping with chlorhexidine cloth before TJR reduced the risk of SSI in patients [25], our results showed that chlorhexidine bathing the night before surgery had no significant effects on reducing infection risk after primary total hip arthroplasty (THA)
We investigated the effects of preoperative chlorhexidine bathing on the prevention of PJI in THA patients

Summary

Introduction

Total hip arthroplasty (THA) is one of the most successful reconstructive procedures in orthopedic surgery today. It is indicated for end-stage hip osteoarthritis due to primary causes, inflammatory disease, osteonecrosis, post-traumatic hip fractures, and residual metastatic tumor or pyogenic hip arthritis. THA has relatively high survivorship and patient-reported satisfaction [1,2,3]. Surgical site infection (SSI) or periprosthetic joint infection (PJI) after THA is a devastating complication that may cause the revision of THA, impairment in daily function and quality of life, and poor outcomes after THA [4,5]

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