Principles of the operating theatre

Topic five covers the principles of the operating theatre, a topic which will be explored through experience when you come and visit the operating theatres in Stanmore. 

The operating theatre

Orthopaedic surgeons take infection control very seriously due to the consequences of implant infection. Certain organisms can adhere and form biofilms on foreign material in the body, including plastic and metal. These biofilms are very difficult to penetrate with antibiotics, and infection within joint replacements is often a reason for revision surgery. This can cause pain in the joint, systemic symptoms of infection, and can spread to the surrounding bone and soft tissues. 

Many precautions are taken to try and prevent infection.

Air - Positive pressure operating theatres are used to ensure a flow of air from within the theatre to outside. All of the air entering the theatre is highly filtered to remove particles and small bacteria. Most orthopaedic operating theatres go one step further and use laminar flow systems. These air delivery systems create a vertical beam of laminar flowing air to blow any microorganisms or particulate matter within the operating theatre away from the patient. 

Surgeon - The surgeon will prepare prior to operating by "scrubbing up". This includes thorough hand washing and donning of a sterile gown and gloves. In some orthopaedic theatres ventilation hoods are worn to cover the head and neck of the surgeon, to further reduce the infection risk.

Patient - The patient is given prophylactic antibiotics prior to most major orthopaedic procedures to reduce the risk of infection. The surgical site is marked with pen and then prepared using a cleaning solution (chlorhexidine is commonly used). The patient will be draped with only the surgical site exposed, ready for the operation. 

Equipment - All of the equipment is sterilised and handled in a sterile manor throughout the operation. 

Other precautions - Some bone cement (polymethylmethacrylate) is impregnated with antibiotics to further lower the risk of periprosthetic infection. 

Watch the videos below to get an idea of how the operating theatre works;

This videos shows the intraoperative use of patient specific instrumentation in a primary total hip replacement.

This video shows a complex acetabular revision with a custom component designed specifically for this patient.