After 300 Charnley low-friction arthroplasties done in two hospitals by
two surgical teams using clean-air enclosures but no preoperative,
operative, or postoperative antibiotics, there were three deep wound
infections, two caused by Staphylococcus albus, coagulase negative, and one
by Klebsiella. Two of these infections occurred in hips previously operated
on and one was in a hip with no previous surgery. These findings suggest
that two operating-room environments using the same basic principles
without antibiotics can achieve a 1 per cent rate of deep wound infection
with no early deep wound infections after total hip replacement, a rate
comparable to that reported in other series in which antibiotics were used.
However, this study did not answer the questions: Is the environment the
primary reason for the low infection rate or is it the discipline required
by the environment? Will the rate of late (four to five years) wound
infection after operations done in a clean-air enclosure be lower than that
after procedures done in a "normal" operating-room environment using
preoperative, operative, and postoperative antibiotics?