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Background    Staphylococcus aureus  is the most common and most important pathogen following knee and hip arthroplasty procedures. Understanding the epidemiology of invasive  S. aureus  infections is important to quantify this serious complication.    Methods  This nested retrospective cohort analysis included adult patients who had undergone insertion of knee or hip prostheses with clean or clean-contaminated wound class at 11 hospitals between 2003–2006. Invasive  S. aureus  infections, non-superficial incisional surgical site infections (SSIs) and blood stream infections (BSIs), were prospectively identified following each procedure. Prevalence rates, per 100 procedures, were estimated.    Results  13,719 prosthetic knee (62%) and hip (38%) insertion procedures were performed. Of 92 invasive  S. aureus  infections identified, SSIs were more common (80%) than SSI and BSI (10%) or BSI alone (10%). The rate of invasive  S. aureus  infection/100 procedures was 0.57 [95% CI: 0.43-0.73] for knee insertion and 0.83 [95% CI: 0.61-1.08] for hip insertion. More than half (53%) were methicillin-resistant. Median time-to-onset of infection was 34 and 26 days for knee and hip insertion, respectively. Infection was associated with higher National Healthcare Safety Network risk index (p ≤ 0.0001).    Conclusions  Post-operative invasive  S. aureus  infections were rare, but difficult-to-treat methicillin-resistant infections were relatively common. Optimizing preventative efforts may greatly reduce the healthcare burden associated with  S. aureus  infections.

Staphylococcus aureus infections following knee and hip prosthesis insertion procedures