A Bundle Protocol to Reduce the Incidence of Periprosthetic Joint Infections after Total Joint Arthroplasty: A Single Center Experience

• Published in: The Journal of arthroplasty 2017-04, Vol.32 (4), p.1067-1073
• Main Authors: Bullock, Matthew W., DO, Brown, Matthew L., MD, Bracey, Daniel N., MD, Langfitt, Maxwell K., MD, Shields, John S., MD, Lang, Jason E., MD
• Format: Article
• Language: English
• Subjects: Arthritis, Infectious; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Knee - adverse effects; bundle protocol; Clinical Protocols; Female; Humans; Incidence; Male; North Carolina - epidemiology; Orthopedics; outcomes; Patient Care Bundles; Patient Readmission - statistics & numerical data; periprosthetic joint infection; Prosthesis-Related Infections - epidemiology; Prosthesis-Related Infections - etiology; Prosthesis-Related Infections - prevention & control; Retrospective Studies; Risk Factors; total hip arthroplasty; total knee arthroplasty
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2016.11.028

Abstract Background Periprosthetic joint infection (PJI) represents a devastating complication of total hip arthroplasty (THA) or total knee arthroplasty (TKA). Modifiable patient risk factors as well as various intraoperative and postoperative variables have been associated with risk of PJI. In 2011 our institution formulated a “bundle” to optimize patient outcomes after THA and TKA. The purpose of this report is to describe the “bundle” protocol we implemented for primary THA and TKA patients and to analyze its impact on rates of PJI and readmission. Methods Our bundle protocol for primary THA and TKA patients is conceptually organized about three chronological periods of patient care: preoperative, intraoperative, and postoperative. The institutional total joint data base and electronic medical record was reviewed to identify all primary THAs and TKAs performed in the two years prior to and following implementation of the bundle. Rates of PJI and readmission were then calculated. Results 13 of 908 (1.43%) TKAs performed before the bundle became infected compared to only 1 of 890 (0.11%) TKAs performed after bundle implementation (p=0.0016). 10 of 641 (1.56%) THAs performed before the bundle became infected, which was not statistically different from the 4 of 675 (0.59%) THAs performed after the bundle that became infected (p=0.09). Conclusions The bundle protocol we describe significantly reduced PJIs at our institution, which we attribute to patient selection, optimization of modifiable risk factors, and our perioperative protocol. We believe the bundle concept represents a systematic way to improve patient outcomes and increase value in total joint arthroplasty.