Clean air and total hip arthroplasty

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The concept of clean air is of common interest to the ecologist and the surgeon, although the adjective clean has a somewhat different connotation to each of these scientists. Attached to the concept of clean air and laminar air flow is an unfortunate emotional connotation. One must separate fact from hypothesis and attribute to these clean air systems only those facts we know. If unproved features are dogmatically attributed to the clean air systems, they will detract from what appears to be a logical, useful, and efficient adjunct in reducing bacterial contamination of surgical wounds.

The orthopaedist’s interest in clean air was further stimulated when total hip replacement arthroplasty was developed for the treatment of diseases of the hip. An infection in the total hip replacement arthroplasty site results in total failure of the operation. This is in contrast to the usually excellent results seen with this operation. Also, total hip replacement arthroplasty may be a more sensitive indicator of infection than many commonly used laboratory bacterial testing systems. The large dead space surrounding the operative area, and the small amount of living tissue in contact with the large endoprosthesis are factors that encourage bacterial growth. Furthermore, materials such as methyl methacrylate and high density polyethylene, which are not entirely inert, add to the likelihood of infection.

Historical considerations

In considering the merits of the clean air system as used in total hip replacement arthroplasty, the historical background of infections and past attempts to eradicate infection should be reviewed. Lister1. . .



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