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Archive Orthopedic Surgery 2019

How We Achieve Zero Joint Infections

Our hip and knee replacement patients head home with healthy, healing scars.

Ronald Singer

Ronald Singer, MD


Pamela Bevelhymer, RN, BSN, CNOR
DEEP TROUBLE Joint infections that occur around implants are difficult to eradicate and subject patients to a significant period of disability.

Since we launched a total joints program nearly 3 years ago, we've performed about 200 knee and hip replacements without a single patient suffering a deep wound infection. That's no small feat for our large orthopedic practice because surgical site infections have dire consequences in joint replacement patients. Infected patients are subjected to several weeks of antibiotic treatments and often must undergo a 2-stage revision surgery to remove and replace the infected implant. Deep wound infections are also expensive to manage — it costs about $18,000 to treat a standard bacterial infection with a revision surgery and more than $100,000 to treat a MRSA SSI — with no guarantee the infection will be eradicated.

We zeroed out our SSI rate in this challenging and high-consequence patient population by focusing on these fundamental infection practices.

1. Identifying at-risk patients

Joint infection patients are at high risk of infection if they have multiple comorbidities, including uncontrolled diabetes, obesity, hypertension or a compromised immune system. Efforts to prevent infection begin with appropriate patient selection and mitigating risk factors in the weeks leading up to surgery:

  • smokers should kick the habit at least 6 weeks out;
  • patients with a body-mass index over 38 should lose weight until their BMI is at an acceptable threshold (< 35, for example); and
  • diabetics should be treated with medication, diet and exercise until their A1C is under 7.

Patients should also improve their diets at least 30 days before surgery by hydrating properly and eating plenty of proteins. (They should continue a high-protein diet for 6 weeks post-op.)

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