Modifiable Risk Factors in Joint Replacement

Modifiable Risk Factors in Joint Replacement

In an article published in The Journal of Arthroplasty, authors 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 percent 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, five days of chlorhexidine showers and use of a specific antibiotic ointment for the nose. Modifications of these protocols including one to three days of chlorhexidine showers and use of either antibiotic ointment in the nose or and 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.

About The Author

William Barrett, MD is a fellowship trained orthopedic surgeon who specializes in primary and revision hip and knee replacement. He performs over 500 hip and knee replacement procedures each year. He is actively involved in clinical research on Anterior Approach Total Hip Replacement (THA), Alternative Bearings for THA, Less Invasive Approaches to joint replacement and use of computerized vs. custom cutting guides for knee replacement. As a nationally recognized joint replacement surgeon, he lectures globally on hip and knee replacement topics. He is active in the American Academy of Orthopaedic Surgeons Continuing Medical Education programs. He is a board examiner for the American Board of Orthopaedic Surgery.

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