Surgical Helmet Systems do not reduce the incidence of periprosthetic joint infections in elbow arthroplasty. Results from the New Zealand National Joint Registry 2000-2023.

Hypothesis And Background: The incidence of prosthetic joint infection (PJI) remains high following elbow arthroplasty procedures. The purpose of this study was to investigate whether Surgical Helmet Systems (SHS) reduce rates of PJI after elbow arthroplasty in a population-based registry study over a consecutive 23-year period. We hypothesized SHS would reduce the incidence of PJI compared with conventional surgical gowns following elbow arthroplasty surgery.

Methods: This is a retrospective review of prospectively collected data using information obtained from The New Zealand National Joint Registry. Patients were categorized using SHSs or conventional gowns. The primary outcome was revision for PJI. The secondary outcome was all cause revision. These were compared between the groups.

Results: 720 elbow arthroplasties were recorded over a consecutive 23-year period (2000-2023) including (670 Total Elbow Arthroplasties (TEA) and 50 hemiarthroplasties (HA). 634 (88%) procedures were performed with conventional gowns. There were 59 revisions in total (7.2% of total operations) and 17 of these were for PJI (2.1% of total operations). The revision rate for all causes was 21.1% in the SHS group and 5.5% in conventional gown group. The revision rate for PJI was 5.6% and 1.9% in the SHS group and conventional gown group, respectively. The revision risk was significantly higher in the SHSs group compared to conventional gown group for both all-cause revision (Hazard Ratio (HR) 3.52, [Confidence Interval (CI) =2.04-6.09] p<0.001) and revisions for PJI (Hazard Ratio 3.26 [CI=1.15-9.26] p=0.019).

Conclusions: The use of SHS compared with conventional surgical gowns was not protective against PJI in elbow arthroplasties in this study. Based on these results, and accepting the limitations of this registry study, we cannot recommend the use of surgical helmet systems as means of infection prevention in primary elbow arthroplasty.