The use of body exhaust suit system in primary total knee arthroplasty: randomised trials

Abstract

Introduction: Two randomised controlled trials were performed to compare the rate of intra-operative contamination in primary total knee arthroplasty (TKA) between the body exhaust suits (BES) and conventional gowns (CON), and to find out the potential source of contamination. Methods: A total of 32 patients undergoing one-stage bilateral TKA were recruited. One knee was assigned to CON group (n=32), and the other knee to BES group (n=32). Wound swabs were collected for bacteria isolation at 5 different stages of the operation. In the second part, one surgeon wore BES and performed simulated TKA for 60 minutes. Glow Germ was applied to both hands. Adhesive tape was applied to the gown-glove interphase on one sleeve. Ultraviolet light was used to detect the leakage of fluorescent spots at 15, 30, 45, and 60 minutes. Results: There was no difference in terms of patients’ preoperative demographics and deformity between the 2 groups. The surgeons touched helmet at a mean of 1.6 ± 1.25 times. None of the intra-operative culture isolated any bacterium. There was no incidence of early periprosthetic infection at 6 months. The gown-glove interphase was found to be the potential source of contamination. The adhesive tape could decrease the leakage of Glow Germ. Conclusion: There is no benefit in the use of BES in decreasing the rate of wound contamination compared with the conventional gowns. The gown-glove interphase is the potential source of contamination, which could be reduced by applying adhesive tapes around the sleeve.