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J R Soc Med. 1983 April; 76(4): 262–265.
PMCID: PMC1438969

Effects of using a Charnley-Howorth enclosure in a district general hospital.


A high rate of infection was found to occur when total hip replacement were performed in an operating theatre used by a variety of surgical specialities. Because of this, a downward displacement laminar flow enclosure was installed to provide ultraclean air operating conditions. Retrospective examination of 419 total hip replacements, carried out over a six-year period during which the enclosure was installed, showed a reduction in the infection rate from 3.2% to 0.4% (P = 0.05) when using the enclosure. The infections were associated with a postoperative wound discharge and with revision surgery but were less frequent when the enclosure was used. Prosthetic loosening was found to be common when metal-to-metal prostheses were used. Working in an enclosure with side panels, wearing body exhaust units, was generally considered to be so noisy as to restrict communication.

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Selected References

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  • Charnley J. Postoperative infection after total hip replacement with special reference to air contamination in the operating room. Clin Orthop Relat Res. 1972 Sep;87:167–187. [PubMed]
  • Charnley J, Eftekhar N. Postoperative infection in total prosthetic replacement arthroplasty of the hip-joint. With special reference to the bacterial content of the air of the operating room. Br J Surg. 1969 Sep;56(9):641–649. [PubMed]
  • Lidwell OM, Lowbury EJ, Whyte W, Blowers R, Stanley SJ, Lowe D. Effect of ultraclean air in operating rooms on deep sepsis in the joint after total hip or knee replacement: a randomised study. Br Med J (Clin Res Ed) 1982 Jul 3;285(6334):10–14. [PMC free article] [PubMed]
  • Salvati EA, Robinson RP, Zeno SM, Koslin BL, Brause BD, Wilson PD., Jr Infection rates after 3175 total hip and total knee replacements performed with and without a horizontal unidirectional filtered air-flow system. J Bone Joint Surg Am. 1982 Apr;64(4):525–535. [PubMed]

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