Use of a provincial surveillance system to characterize postoperative surgical site infections after primary hip and knee arthroplasty in Alberta, Canada


      • Surveillance is used to discover pathogens of surgical site infection posthip and -knee arthroplasty.
      • Infections after knee arthroplasty tend to occur later versus hip arthroplasty.
      • Preoperative colonization with methicillin-resistant Staphylococcus aureus (MRSA) is more likely to cause an MRSA surgical site infection.


      Knee and hip replacements are an effective intervention for improving quality of life. Rates of these surgeries in North America are growing, coinciding with increasing obesity and an aging population.


      Alberta Health Services' infection prevention and control program collects data prospectively on surgical site infections (SSIs) after primary total hip and knee arthroplasty completed in Alberta, Canada. We reviewed all SSIs within 180 days of surgical procedures between March 1, 2012, and June 30, 2014.


      There were 312 SSI cases reviewed. Rates of SSI (per 100 procedures) were 1.77 and 1.26 for hip and knee arthroplasties, respectively. Seventy-nine percent of infections occurred within 30 days postoperatively. Stratified by time to infection, larger proportions of knee SSIs occurred after 30 days versus hip SSI. Colonization with methicillin-resistant Staphylococcus aureus (MRSA) was associated with subsequent infection (odds ratio, 40; 95% confidence interval, 10.2-154.2). We have identified important characteristics that may be helpful for determining optimal prevention strategies.


      Intensive postoperative follow-up within 30 days of knee arthroplasty may help to identify SSI early, allowing for prompt treatment and avoiding the need for invasive therapy, such as surgery for hardware revision. Decolonization techniques may decrease subsequent MRSA SSI in colonized patients.

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        • Canadian Institute for Health Information/Institut canadien d'information sur la sante
        Hip and knee replacements in Canada: Canadian Joint Replacement Registry Annual Report 2014.
        (Available from:) (Accessed April 19; 2016)
        • Agency for Healthcare Research and Quality
        (Available from:) (Accessed November 4)
        • Canadian Institute for Health Information/Institut canadien d'information sur la santé
        Hospitalizations, early revisions and infections following joint replacement surgery 2008.
        (Available from:) (Accessed November 4)
        • Miletic K.G.
        • Taylor T.N.
        • Martin E.T.
        • Vaidya R.
        • Kaye K.S.
        Readmissions after diagnosis of surgical site infection following knee and hip arthroplasty.
        Infect Control Hosp Epidemiol. 2014; 35: 152-157
        • Kurtz S.M.
        • Lau E.
        • Watson H.
        • Schmier J.K.
        • Parvizi J.
        Economic burden of periprosthetic joint infection in the United States.
        J Arthroplasty. 2012; 27: 61
        • Zimmerli W.
        • Trampuz A.
        • Ochsner P.E.
        Prosthetic-joint infections.
        N Engl J Med. 2004; 351: 1645-1654
        • Horan T.C.
        • Andrus M.
        • Dudeck M.A.
        CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting.
        Am J Infect Control. 2008; 36: 309-332
        • Osmon D.R.
        • Berbari E.F.
        • Berendt A.R.
        • Lew D.
        • Zimmerli W.
        • Steckelberg J.M.
        • et al.
        Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America.
        Clin Infect Dis. 2013; 56: e1-25
        • Benito N.
        • Franco M.
        • Coll P.
        • Gálvez M.L.
        • Jordán M.
        • López-Contreras J.
        • et al.
        Etiology of surgical site infections after primary total joint arthroplasties.
        J Orthop Res. 2014; 32: 633-637
        • Willis-Owen C.A.
        • Konyves A.
        • Martin D.K.
        Factors affecting the incidence of infection in hip and knee replacement: an analysis of 5277 cases.
        J Bone Joint Surg Br. 2010; 92: 1128-1133
        • Lewis S.S.
        • Dicks K.V.
        • Chen L.F.
        • Bolognesi M.P.
        • Anderson D.J.
        • Sexton D.J.
        • et al.
        Delay in diagnosis of invasive surgical site infections following knee arthroplasty versus hip arthroplasty.
        Clin Infect Dis. 2015; 60: 990-996
        • Peel T.N.
        • Cheng A.C.
        • Buising K.L.
        • Choong P.F.M.
        Microbiological aetiology, epidemiology, and clinical profile of prosthetic joint infections: are current antibiotic prophylaxis guidelines effective? Antimicrobial Agents and Chemotherapy.
        Am Soc Microbiol. 2012; 56: 2386-2391
        • Ryu S.Y.
        • Greenwood-Quaintance K.E.
        • Hanssen A.D.
        • Mandrekar J.N.
        • Patel R.
        Low sensitivity of periprosthetic tissue PCR for prosthetic knee infection diagnosis.
        Diagn Microbiol Infect Dis. 2014; 79: 448-453
        • Tande A.J.
        • Patel R.
        Prosthetic joint infection. Clinical microbiology reviews.
        Am Soc Microbiol. 2014; 27: 302-345
        • Trampuz A.
        • Piper K.E.
        • Jacobson M.J.
        • Hanssen A.D.
        • Unni K.K.
        • Osmon D.R.
        • et al.
        Sonication of removed hip and knee prostheses for diagnosis of infection.
        N Engl J Med. 2007; 357: 654-663
        • Suda A.J.
        • Kommerell M.
        • Geiss H.K.
        • Burckhardt I.
        • Zimmermann S.
        • Zeifang F.
        • et al.
        Prosthetic infection: improvement of diagnostic procedures using 16S ribosomal deoxyribonucleic acid polymerase chain reaction.
        Int Orthopaed. 2013; 37: 2515-2521
        • Murphy E.
        • Spencer S.J.
        • Young D.
        • Jones B.
        • Blyth M.J.G.
        MRSA colonisation and subsequent risk of infection despite effective eradication in orthopaedic elective surgery.
        J Bone Joint Surg Br. 2011; 93: 548-551
        • Moroski N.M.
        • Woolwine S.
        • Schwarzkopf R.
        Is preoperative staphylococcal decolonization efficient in total joint arthroplasty.
        J Arthroplasty. 2015; 30: 444-446
        • Chen A.F.
        • Heyl A.E.
        • Xu P.Z.
        • Rao N.
        • Klatt B.A.
        Preoperative decolonization effective at reducing staphylococcal colonization in total joint arthroplasty patients.
        J Arthroplasty. 2013; 28: 18-20
        • Schweizer M.L.
        • Chiang H.-Y.
        • Septimus E.
        • Moody J.
        • Braun B.
        • Hafner J.
        • et al.
        Association of a bundled intervention with surgical site infections among patients undergoing cardiac, hip, or knee surgery.
        JAMA. 2015; 313: 2162-2171