A Two-Year Audit of Deep Infection Rate After Total Hip Arthroplasty at Tertiary Care Hospital Lahore

Abstract

Background: Deep infections following total hip arthroplasty (THA) are serious complications that can lead to significant morbidity, prolonged hospital stays, increased healthcare costs, and revision surgeries. Identifying risk factors and causative organisms is essential for prevention and effective management, particularly in resource-limited settings.
Aim: To audit the incidence, risk factors, and microbiological spectrum of deep surgical site infections following THA over a two-year period at a tertiary care hospital in Pakistan.
Methods: This retrospective audit was conducted at the Orthopaedic Department of King Edward Medical University/Mayo Hospital, Lahore, from August 2017 to July 2019. All patients who underwent primary or revision THA during the study period were included. Data were extracted from operative records, follow-up notes, and microbiology reports. Only cases meeting CDC criteria for deep infection were analyzed. Descriptive statistics and chi-square tests were used to assess associations between deep infection and clinical risk factors using SPSS v22.
Results: Out of 150 THA procedures, 9 cases (6%) developed deep infections. The infection rate was higher in revision THA (12%) than in primary procedures (4.8%). Significant associations were observed between deep infection and diabetes mellitus (p=0.011), obesity (p=0.026), and prolonged surgery >120 minutes (p=0.018). The most frequently isolated pathogens were Staphylococcus aureus (MSSA and MRSA), followed by Escherichia coli and Pseudomonas aeruginosa. Mean time to infection diagnosis was 21 ± 7.5 days post-surgery.
Conclusion: Deep infection after THA is influenced by modifiable risk factors. Preoperative optimization and timely surgical intervention are critical in reducing infection rates.