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Views: 0 Author: Site Editor Publish Time: 2026-04-13 Origin: Site
Orthopedic surgical site infection (SSI) refers to infections occurring at the incision or deep tissue following orthopedic procedures, often leading to wound complications that require clinical intervention. SSI is one of the most serious complications after orthopedic surgery.
The reported incidence ranges from 0.4% to 16.1% globally, and can reach as high as 50%–60% in high-energy fractures and open injuries. The consequences are significant, including prolonged hospitalization, increased risk of amputation, and even life-threatening conditions. Additionally, treatment complexity and duration substantially increase healthcare costs.
With the growing problem of antimicrobial resistance, managing infected orthopedic wounds has become increasingly challenging. Currently, there is no universally standardized protocol for prevention and treatment, and variations in medical resources across regions further contribute to inconsistent clinical outcomes.
This consensus establishes a comprehensive management system covering prevention, diagnosis, treatment, reconstruction, and rehabilitation, aiming to improve patient outcomes and optimize healthcare efficiency.
Proper skin cleaning should be performed before surgery. Hair removal is not recommended unless necessary; if required, non-traumatic methods should be used to avoid skin damage.
Strict aseptic techniques must be followed, and maintaining patient body temperature during surgery is essential to reduce infection risk.
Unless contraindicated, 75% ethanol-based antiseptics are recommended for skin preparation. Before wound closure, irrigation with povidone-iodine solution should be performed. Standard perioperative antibiotic prophylaxis is strongly recommended.
Reusable orthopedic instruments should be centrally managed by the Central Sterile Supply Department (CSSD), ensuring standardized cleaning, disinfection, and sterilization processes.
For surgeries involving implants, surgeons and nurses are advised to wear double gloves and replace the outer gloves before implant placement.
Key measures include minimizing operation time, assessing skin necrosis risk before closure, avoiding excessive tension during suturing, and preventing dead space formation.
Diagnosis should be based on symptoms such as redness, swelling, warmth, pain, purulent discharge, necrotic tissue, sinus tract formation, and exposure of deep tissues or implants.
Early and standardized microbiological testing is essential to identify causative pathogens and guide targeted antibiotic therapy.
Comprehensive assessment should include laboratory tests, imaging studies, and histopathological examination to evaluate the extent of infection.
Empirical antibiotics should be initiated after sampling for microbiological testing. Once results are available, therapy should be adjusted accordingly.
Treatment duration typically ranges from 6 to 12 weeks, depending on infection severity. Complex bone infections may require longer courses.
For severe infections or implant-related cases, systemic antibiotics should be combined with local treatments such as antibiotic-loaded bone cement, artificial bone substitutes, or negative pressure wound therapy (NPWT).
Effective debridement requires removal of necrotic tissue, elimination of dead space, and adequate drainage to promote healing and reduce recurrence.
The decision to retain implants should be carefully evaluated:
Implants may be retained if fixation is stable and infection is controllable
Removal is recommended if infection is uncontrolled or associated with bone necrosis
Tendon repair infections require removal of retained sutures and necrotic tendon tissue
Joint-related infections require thorough irrigation and drainage
Deep or closed infections may benefit from continuous irrigation and drainage systems
Small wounds without exposure of critical structures may be closed directly after debridement.
For larger soft tissue defects without exposure of bone or tendons, skin grafting can be performed if the wound bed is suitable.
Complex wounds with exposed bone, tendon, or neurovascular structures require flap or musculocutaneous flap reconstruction.
In severe, uncontrollable infections with irreversible functional loss, amputation may be necessary to prevent systemic complications.
Rehabilitation should begin early after infection control to maintain joint mobility and prevent stiffness.
Rehabilitation programs should focus on restoring daily function and include:
Muscle strength training
Range of motion exercises
Balance training
Activities of daily living (ADL) training
Orthopedic SSI remains a major clinical challenge requiring a multidisciplinary and standardized approach. Through systematic prevention, early diagnosis, effective infection control, proper surgical management, and structured rehabilitation, patient outcomes can be significantly improved while reducing healthcare burden.
Bacterial contamination during or after surgery is the primary cause, particularly in cases involving implants or open fractures.
Treatment typically lasts 6–12 weeks but may extend longer in complex bone infections.
No. Implant retention depends on infection control, bone stability, and absence of necrosis.
Negative pressure wound therapy helps control infection, promote granulation tissue formation, and accelerate wound healing.
