An integrated approach for appraisal the role of microbial air contamination and antibiotic prophylaxis in hip and knee arthroprosthesis surgery

Since the MRC study demonstrated an association between air microbial contamination and deep SSI in hip and knee arthroprosthesis, it is recommended to perform these procedures in ultraclean operating theatres (OT) with air microbial contamination value not higher than 10 cfu/m3 measured by active sampling or 2 cfu/plate/h by passive sampling. A recent retrospective study (Brandt et al, 2008) unexpectedly showed significant higher SSI rates using unidirectional airflow in the OT for hip prosthesis and no differences for knee prosthesis. It is therefore essential to evaluate the usefulness of this ventilation system for cost-effectiveness.