Clean air at operation and subsequent sepsis in the joint.

When Charnley and others began to do substantial numbers of arthroplasties, they met a high incidence of subsequent failure from sepsis. There was at that time a revival of interest in the possibility that surgical sepsis originated from airborne bacteria, and engineering developments had provided the means for attaining much cleaner atmospheres. Over a period of ten years, Charnley reduced airborne contamination by more than 100-fold, and his sepsis rate fell, without using antibiotics, by tenfold. He had, however, made other procedural changes, and there were those who reported equally good results without using the ventilation and clothing systems he had devised, although usually they had given prophylactic antibiotics. The results of recent randomized studies have confirmed that considerable reduction in the sepsis rate can be obtained by operating in ultraclean air but that similarly low rates can be achieved with normal ventilation when prophylactic antibiotics are given. In addition, the two methods are effective independently, and used together sepsis rates in the joint after total arthroplasty have been reduced to a few per 1000.