Letter to the Editor regarding "Risk of surgical site infection associated with intraoperative smartphone use in a sterile cover during total knee arthroplasty".

Abstract

To critically examine the interpretation of the reported association between intraoperative smartphone use in a sterile cover and surgical site infection after total knee arthroplasty. We appraised the study's infection definition and surveillance period, statistical precision, interpretation of nonsignificant findings, and reporting of the institutional infection-prevention bundle. Defining the outcome as periprosthetic joint infection within one year may capture events less plausibly attributable to intraoperative contamination. Reporting infections separately at 30 and 90 days would strengthen temporal and causal interpretation. The small number of events and wide confidence interval do not establish equivalence or non-inferiority in the absence of a prespecified margin and adequate statistical power. In addition, incomplete reporting of antimicrobial prophylaxis, decolonisation, skin preparation, perioperative glucose control, and operating-theatre conditions limits external validity. The findings are best interpreted as showing no detected increase in infection risk under a single institution's protocol rather than demonstrating the safety of intraoperative smartphone use. Future multicentre, protocolised non-inferiority studies should use a prespecified margin, adequately powered samples, standardised 90-day surveillance, and transparent reporting of co-interventions.