Charnley and Eftekhar tracked deep prosthetic joint infection in 2085 consecutive THAs at Wrightington Hospital from 1959 to 1967. Operating room air quality improved through four sequential phases, from a primitive extractor-fan theatre to a near-sterile filtered-air enclosure. The study asks whether airborne bacterial contamination drives postoperative infection after hip replacement — and what explains the infection rate that persists even in sterile air.
In 1959, THA carried a nearly 9% deep infection rate — comparable to what we now see only in the most contaminated wound classes. There was no consensus that the operating room air itself was the driver, and the role of implanted plastics and cement was genuinely uncertain.
This paper is the quantitative foundation for every specialized arthroplasty theatre you will operate in. The stepwise infection data gave Charnley the evidence to build laminar flow enclosures, and the observation that a 1.3% floor persisted despite near-sterile air drove the development of total body exhaust suits and modern impermeable gown standards.
When your RA patient develops a PJI, remember the 1.76:1 infection risk ratio established here. Counsel these patients preoperatively that their baseline risk is meaningfully higher, independent of surgical technique.
The disappearance of environmental organisms in near-sterile air is also a useful diagnostic concept: if you culture B. Proteus or Staph. Albus from a PJI, think exogenous contamination from the operative environment, not endogenous seeding.
Charnley and Eftekhar tracked deep prosthetic joint infection in 2085 consecutive THAs at Wrightington Hospital from 1959 to 1967. Operating room air quality improved through four sequential phases, from a primitive extractor-fan theatre to a near-sterile filtered-air enclosure. The study asks whether airborne bacterial contamination drives postoperative infection after hip replacement — and what explains the infection rate that persists even in sterile air.
In 1959, THA carried a nearly 9% deep infection rate — comparable to what we now see only in the most contaminated wound classes. There was no consensus that the operating room air itself was the driver, and the role of implanted plastics and cement was genuinely uncertain.
This paper is the quantitative foundation for every specialized arthroplasty theatre you will operate in. The stepwise infection data gave Charnley the evidence to build laminar flow enclosures, and the observation that a 1.3% floor persisted despite near-sterile air drove the development of total body exhaust suits and modern impermeable gown standards.
When your RA patient develops a PJI, remember the 1.76:1 infection risk ratio established here. Counsel these patients preoperatively that their baseline risk is meaningfully higher, independent of surgical technique.
The disappearance of environmental organisms in near-sterile air is also a useful diagnostic concept: if you culture B. Proteus or Staph. Albus from a PJI, think exogenous contamination from the operative environment, not endogenous seeding.