NZ registry laminar flow and space suits

Does the use of laminar flow and space suits reduce early deep infection after total hip and knee replacement?: the ten-year results of the New Zealand Joint Registry.

Hooper GJ, Rothwell AG, Frampton C, et al. The Journal of bone and joint surgery. British volume 2011 · PMID 21196549 · doi:10.1302/0301-620x.93b1.24862

Question

Are laminar flow theatres and space suits associated with lower early revision for deep infection after hip and knee replacement?

Design

Ten-year analysis of the New Zealand Joint Registry.

Patients

Primary total hip and knee replacements recorded in the New Zealand Joint Registry.

Intervention

Laminar flow ventilation and/or space suits

Comparison

Conventional ventilation without space suits

Primary outcome

Revision for deep infection within six months

Key result

Laminar flow and space suits were not associated with lower early revision for deep infection; early infection revision was significantly higher with their use in both hip and knee replacement, independent of age, diagnosis and operating time.

Limitations

Registry data cannot control for case mix and theatre behaviour, and only early revision for infection was captured.

Impact on practice

It challenged the assumption that modern laminar flow and space suits lower infection risk and is regularly cited in exam discussions of theatre ventilation. UK practice still uses laminar flow for arthroplasty.