Scientific Articles   |    
How to Minimize Infection and Thereby Maximize Patient Outcomes in Total Joint Arthroplasty: A Multicenter ApproachAAOS Exhibit Selection
Kenneth David Illingworth, MD1; William M. Mihalko, MD, PhD2; Javad Parvizi, MD3; Thomas Sculco, MD4; Benjamin McArthur, MD4; Youssef el Bitar, MD1; Khaled J. Saleh, BSc, MD, MSc, FRCS(C), MHCM1
1 Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, P.O. Box 19679, Springfield, IL 62794-9679. E-mail address for K.J. Saleh: ksaleh@siumed.edu
2 Department of Orthopaedic Surgery, Campbell Clinic, University of Tennessee, 1400 South Germantown Road, Germantown, TN 38138
3 Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107
4 Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, 525 East 71st Street, New York, NY 10021
View Disclosures and Other Information
  • Disclosure statement for author(s): PDF

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, one or more of the authors has had another relationship, or has engaged in another activity, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Apr 17;95(8):e50 1-13. doi: 10.2106/JBJS.L.00596
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case



Total joint arthroplasty is one of the most common and most successful orthopaedic procedures. Infection after total joint arthroplasty is a devastating problem that expends patient, surgeon, and hospital resources, and it substantially decreases the chances of a successful patient outcome. Postoperative infection affects approximately 1% to 7% of all total joint arthroplasties, at a cost of approximately $50,000 per infection. Decreasing postoperative periprosthetic joint infection is of the utmost importance for the total joint arthroplasty surgeon. Preoperative, perioperative, intraoperative, and postoperative measures to minimize infection and optimize patient outcomes in total joint arthroplasty are discussed. Preoperative measures include management of patients colonized by Staphylococcus aureus, nutritional optimization, and management of medical comorbidities. Perioperative measures include skin preparation and prophylactic antibiotics. Intraoperative measures include body exhaust suits, laminar flow, ultraviolet light, operating-room traffic control, surgical suite enclosures, anesthesia-related considerations, and antibiotic-loaded bone cement. Postoperative measures include continued antibiotic prophylaxis, blood transfusions, hematoma formation and wound drainage, duration of hospital stay, and antibiotic prophylaxis for future invasive procedures.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org


    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe

    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    Results provided by:
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    OK - The University of Oklahoma
    VA - OrthoVirginia
    OH - University Hospitals Case Medical Center
    LA - Ochsner Health System