The association between laminar vs turbulent airflow and prosthetic hip joint infections: a prospective nationwide study from the Danish Hip Arthroplasty Register.

Background and purpose:  There is a controversy as to whether operating rooms with laminar airflow (LAF) ventilation are less associated with prosthetic joint infection (PJI) following total hip arthroplasty (THA) than turbulent airflow (TAF) ventilation. We aimed to assess the association of LAF and TAF ventilation with PJI following primary THA.

Methods:  This prospective cohort study, based on Danish administrative databases, included patients from all Danish hospitals. Patients with a primary THA with at least 365 days of follow-up between 2010 and 2020 were included from the Danish Hip Arthroplasty Register (DHR). The patients were then linked to the Danish microbiology register. The primary outcome was revision due to PJI within 365 days after primary surgery, analyzed with multivariable Cox models and Gray's test comparing LAF with TAF. PJI was defined by either a PJI diagnosis registered in the DHR after revision or 2 or more positive cultures with identical bacteria in the perioperative biopsies taken during revision.

Results:  Of the 92,152 THAs (78,181 patients) included, 2,328 (2.5%) had revision surgery within 365 days. Of these, 843 (0.91%) were due to PJI (0.92% in LAF, 0.89% in TAF). After adjusting for patient- and surgery-related risk factors, and year of surgery, we found no difference in the PJI hazard between LAF and TAF (HR 0.99; 95% confidence interval 0.78-1.26).

Conclusion:  Our data indicate that there is no difference in the risk of PJI comparing LAF with TAF ventilation in primary THA in Denmark.