Periprosthetic joint infections can be reduced by optimizing
at-risk patients, screening for
methicillin-resistant Staphylococcus aureus and
properly preparing the skin perioperatively, according to a presentation at the
Current Concepts in Joint Replacement 2011 Winter Meeting
It is a known fact the incidence of periprosthetic joint infection
is on the rise and, unfortunately, that rise is going to pose many challenges
to us in
prevention, diagnosis and treatment, Orthopedics
Today Editorial Board member Javad Parvizi, MD, FRCS, said.
Optimizing patients for surgery to prevent perioperative joint infection
(PJI) is essential, he said. This includes treating oral, gastrointestinal,
genitourinary, skin and nail infections before surgery. Additionally, patients
with uncontrolled diabetes or on anti-inflammatory medications who are at
extreme risk of developing PJI should not be operated on
electively, according to Parvizi.
Highlighting one take home message, he said, Skin preparation is
very important and, in my opinion, starts at home.
Alcohol must be part of the skin preparation; otherwise, your
agent will not work, he said.
Because surgical gloves are a source of contamination, double
gloving is a must during total joint arthroplasty, Parvizi said.
According to Parvizis research, there is no science suggesting
that laminar airflow, protective space suits and the size and
volume of the operating room affects PJI rates. But what is known is that
wound contamination occurs during surgery and this is, the majority of the
time, by direct fallout or contact with a contaminated glove or an instrument.
The primary source of bacteria in the operating room is the OR personnel,
In discussing the prevention of PJI, Parvizi noted, One of the
most effective agents in prevention of periprosthetic joint infection and
surgical site infection is administration of appropriate and timely
perioperative antibiotics. Currently, second-generation cephalosporins remain
the most effective agents and they have excellent tissue activity against the
majority of organisms, including gram-positive cocci. They have a long
half-life and good tissue penetration.
- Parvizi J. Minimizing infection risk: Fortune favors the prepared
mind. Paper #37. Presented at the Current Concepts in Joint Replacement 2011
Winter Meeting. Dec. 7-10. Orlando, Fla.
- Disclosure: Parvizi has no relevant financial disclosures.