Assessing Residual Moisture After Sterilization as an Overlooked Source of Intraoperative Bacterial Contamination in Knee Intra-articular Reconstructions: Evaluating the Reliability of Routine Procedures and Tests

2025

Residual Moisture and Infection Rates in Knee Surgeries

Sample size: 520 publication Evidence: moderate

Author Information

Author(s): Malinowski Konrad MD, PhD, Bawor Michalina MD, PhD, Woon Kim Dong, Pękala Przemysław A. MD, PhD, Skowronek Paweł MD, PhD, Prof., Hirschmann Michael T. MD, PhD, Domżalski Prof. Marcin MD, PhD, LaPrade Robert F. MD, PhD, Mostowy Marcin MD

Primary Institution: Artromedical Orthopedic Clinic, Bełchatów, Poland

Hypothesis

Residual moisture on surgical tools due to autoclave overloading would not be detected by autoclave self-diagnostics, chemical and biological tests, or organoleptic assessment.

Conclusion

Residual moisture after the sterilization process is an underestimated source of postoperative joint infections, especially in knee intra-articular reconstruction procedures.

Supporting Evidence

21.2% of knee intra-articular ligament reconstructions were complicated by postoperative joint infections.
Compared to 1.5% in knee nonreconstruction arthroscopies and 0.4% in knee extra-articular/other joints procedures.
The source of increased infection rate was identified as residual moisture on surgical tools due to autoclave overloading.
After reducing the insert of surgical tools in the autoclave, the infection rate returned to <1%.

Takeaway

If surgical tools are too wet after being sterilized, it can cause infections in patients after knee surgeries. This is often missed because the sterilization tests don't show any problems.

Methodology

A retrospective analysis of increased postoperative knee infection rates was performed, comparing infection rates among different types of knee surgeries.