One of the most serious complications of any joint replacement is infection. Avoidance of infection is a primary focus and begins well before the actual case starts. While risk of surgical infection is primarily dependent on the medical, biologic and immune status of the patient, there are areas that we address to optimize patients for surgery.
One of the most serious complications of any joint replacement is infection. Avoidance of infection is a primary focus and begins well before the actual case starts. While risk of surgical infection is primarily dependent on the medical, biologic and immune status of the patient, there are areas that we address to optimize patients for surgery.
Preoperative
Preoperative
Nutritional evaluation and Surgical optimization:
Nutritional evaluation and Surgical optimization:
-Assessment of protein, pre-albumin, Absolute Lymphocyte Count, and white cell count among others. These are indicators of good biologic function.
-Assessment of protein, pre-albumin, Absolute Lymphocyte Count, and white cell count among others. These are indicators of good biologic function.
-Lean protein and vegetable rich diet. Focus on lean protein: beans, fish, chicken, soy. Probiotic intake from yogurt and probiotic supplementation should also be included daily both before and after surgery.
-Lean protein and vegetable rich diet. Focus on lean protein: beans, fish, chicken, soy. Probiotic intake from yogurt and probiotic supplementation should also be included daily both before and after surgery.
-Daily multivitamin
-Daily multivitamin
-Vitamin D3: 5,000 Units daily for 8 weeks perioperatively
-Vitamin D3: 5,000 Units daily for 8 weeks perioperatively
-Nicotine cessation
-Nicotine cessation
-Diabetes management: Goal Hemoglobin A1c below 6.5
-Diabetes management: Goal Hemoglobin A1c below 6.5
-Weight management: Goal Body Mass Index (BMI) below 35
-Weight management: Goal Body Mass Index (BMI) below 35
-Medication review: Some medications for rheumatoid arthritis, organ transplant maintenance, and cancer therapy may impede healing and defense against infection.
-Medication review: Some medications for rheumatoid arthritis, organ transplant maintenance, and cancer therapy may impede healing and defense against infection.
Perioperative
Perioperative
Infection prevention:
Infection prevention:
- Application of antibacterial wipes in the immediate perioperative setting.
- Application of antibacterial wipes in the immediate perioperative setting.
- A nasal application of an antibacterial solution for mitigation of MRSA bacterial colonization.
- A nasal application of an antibacterial solution for mitigation of MRSA bacterial colonization.
- Surgical skin preparation with alcohol followed by chlorhexidine preparation
- Surgical skin preparation with alcohol followed by chlorhexidine preparation
- Preoperative antibiotic administration
- Preoperative antibiotic administration
- Minimum room traffic
- Minimum room traffic
- Efficient use of OR time
- Efficient use of OR time
- Continuous attention to maintenance of the sterile field.
- Continuous attention to maintenance of the sterile field.
Postoperative
Postoperative
We maintain 24 hours of antibiotic coverage per standard of care. In some patients with history of infection, immune compromise, or complicated cases, this may be extended.
We maintain 24 hours of antibiotic coverage per standard of care. In some patients with history of infection, immune compromise, or complicated cases, this may be extended.
Continuing a daily multivitamin, 5,000 Vitamin D3, lean protein and vegetable rich diet.
Continuing a daily multivitamin, 5,000 Vitamin D3, lean protein and vegetable rich diet.
The wound is usually covered with an occlusive dressing that may be left in place until first clinic follow up.
The wound is usually covered with an occlusive dressing that may be left in place until first clinic follow up.
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