Four cohort studies using the endpoint severe SSI following knee prosthesis and four studies following hip prosthesis were included. No individual study showed a significant benefit for LAF following knee prosthesis but one small study showed a significant benefit following hip prosthesis. However, one individual study showed significantly higher severe SSI rates following knee prosthesis and three studies significantly higher SSI rates following hip prosthesis under LAF conditions. The summary odds ratio was 1.36 (95% confidence interval: 1.06–1.74) for knee prosthesis and 1.71 (1.21–2.41) for hip prosthesis.
It would be a waste of resources to establish new operating rooms with LAF, and questionable as to whether LAF systems in existing operating rooms should be replaced by conventional ventilation systems.