Risk factors for superficial wound complications in hip and knee arthroplasty

Superficial wound complications have been consistently implicated in the development of prosthetic joint infection. This cohort study aimed to determine perioperative risk factors associated with superficial wound complications. The study was performed over an 18-month period (January 2011 to June 2012) and included 964 patients undergoing prosthetic hip or knee replacement surgery. The factors associated with superficial wound complication differed according to arthroplasty site. In the combined cohort the following factors were associated with superficial wound complications: the use of 0.5% chlorhexidine in 70% alcohol for surgical skin preparation compared with 1% iodine in 70% alcohol (odds ratio (OR) 4.75; 95% confidence interval (CI) 1.42, 15.92; p = 0.012); increasing age (OR, 1.13; 95% CI, 1.06,1.19; p 0.18); increasing body mass index (BMI) (OR, 1.08; 95% CI, 1.05,1.12; p < 0.001); rheumatoid arthritis (OR, 2.56; 95% CI, 1.17, 5.58; p 0.018); and increasing blood transfusions (OR, 1.26; 95% CI, 1.06,1.49; p 0.008). In the hip arthroplasty cohort, the use of 0.5% chlorhexidine in 70% alcohol for surgical skin preparation (OR, 13.35; 95% CI, 2.11, 84.29; p 0.006), increasing BMI (OR, 1.13; 95% CI, 1.06, 1.19; p < 0.001) and increasing blood transfusions (OR, 1.26; 95% CI, 1.06, 1.49; p 0.008) were associated with superficial wound complications. In the knee arthroplasty cohort rheumatoid arthritis (OR, 2.75; 95% CI, 1.03, 7.33; p 0.043) and increasing tourniquet time (OR, 1.01; 95% CI, 1.00, 1.02; p = 0.029) were independent predictors of superficial wound complications. Further research is warranted to assess the impact of modification of these factors on the subsequent development of wound complications and prosthetic joint infection.