In an article published in The Journal of Arthroplasty, author Stambough et al. outlined the efficacy of controlling modifiable risk factors, specifically the decolonization of patients for Staph bacteria. There are multiple modifiable risk factors that can be improved prior to elective joint replacement surgery. These include the patients weight, smoking cessation, optimizing medical comorbidities. The authors of this article talk about the value of using universal decolonization, that is treating all patients prior to surgery to eliminate the 20% of individuals who carry Staph on their skin or mucous membranes. They compared universal decolonization with a screening/treating protocol where patients are screened and those who are positive for carrying Staph bacteria are treated. What the authors found is that it was more economical and outcomes were improved in the universal decolonization. This involves, in this particular study, 5 days of chlorhexidine showers and use of a specific antibiotic ointment for the nose. Modifications of these protocols including 1 to 3 days of chlorhexidine showers and use of either antibiotic ointment in the nose or an iodine solution have been utilized to decrease the risk of bacterial contamination of the patient. These and other studies point to the importance of optimizing modifiable risk factors prior to elective joint replacement surgery. This requires some coordination between the patient, the doctors’ office, and the hospital prior to surgery, but optimizing these various factors can lead to a better outcome with fewer complications.
Dr. Barrett is an Eastside orthopedic surgeon who performs over 500 joint replacement surgeries annually. For more information about total hip and knee replacements, contact Proliance Orthopedic Associates at 425.656.5060.