Sepsis after Total Hip or Knee Joint Replacement in Relation to Airborne Contamination [and Discussion]

The beginning of aseptic surgery was marked by the hypothesis that surgical infection might be caused by particles from the air. The importance of other ways of contaminating the wound soon became apparent, however, and these seemed to predominate. With the development of operations for total joint replacement large numbers of operations began to be done on clean tissue with maximal exposure to the air of the operating room. The incidence of infection was high and the airborne hypothesis was advanced as the reason. Extensive investigations with clean-air systems gave support to this. A recently completed control study has concluded that in conventional ventilated operating rooms over 90% of the bacterial contamination of the wound comes from the air and that cleaner air results in a lower risk of sepsis.