The effect of Space Suits on intraoperative wound contamination in patients undergoing knee replacement surgery.

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Deep infection following total joint replacement remains a devastating complication for both the patient and the health sector. It is estimated that a single deep infection following a THJR incurs a cost of around $150,000. To combat this problem, Charnely pioneered the use of body exhaust suits which were later validated. A large MRC trial reported by Lidwel in the 1980s showed a marked reduction in infection rates with the use of laminar flow ventilation and body exhaust suits (BES), leading to their widespread introduction. However, modern body suit systems have eschewed the use of the full body exhaust system due to its cumbersome nature and cost. These ‘Space Suit’ systems have not been studied as extensively as the previous BES suits and use a helmet based fan. This fan creates a positive pressure situation inside the gown which is quite distinct from the previous BES suits, and may lead to disruption of the theatre airflow and cause particles shed from the surgical team to be deposited within the sterile field. The New Zealand Joint Registry data suggests that spacesuit use is linked to an increase in the rate of early joint arthroplasty infections. This runs counter to expectations, and many surgeons have concluded the registry data is flawed. This randomised controlled trial will use real tissue samples during TKJR to investigate whether the use of spacesuits increases the likelihood of wound contamination, and therefore infections. The analysis of wound samples is to be done by PCR and TSMI which has been shown to be a sensitive and specific measure of real wound contamination

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