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Surgical technique, antibiotics important for preventing infection
Good wound closure is a key surgical aspect that is often neglected.
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The proper use of perioperative antibiotics and a good surgical approach are vital to reducing infection rates following total hip replacement, according to a surgeon speaking at the American Academy of Orthopaedic Surgeons 72nd Annual Meeting.
“The most effective methods for us to reduce infection are first, and most important, the prophylactic use of antibiotics 24 hours postoperatively and, particularly in high-risk patients, the use of antibiotic cements,� Arlen D. Hanssen, MD, said during a presentation at The Hip Society Specialty Day.
Using clean rooms also helps reduce infection incidence. “But I think that you, as a surgeon ... the one variable you really have under your control ... is your surgical technique,� he said.
“I think you have to look at case complexity and think about your approach. It isn’t always intuitive, but sometimes, for example, attempts to minimize tissue damage might markedly increase your operative duration. I think you have to look at this in balance [to] avoid the complications that require early postoperative intervention,� he said, noting good wound closure is also one particularly important aspect of surgery that is often neglected.
In diagnosing infection, imaging technologies can occasionally be useful, but isolating C-reactive proteins and using selective joint aspiration are basically all that are needed, Hanssen said.
“I think it will not be too far in the future where we will have baseline markers allowing us to follow patients during the first month to try to determine whether they have an infection,� he said.
“That is important because you have a window of opportunity in the first month to salvage the implant if it becomes infected. If you do not have a successful attempt [at salvaging the implant], all of these become chronic infections, and that means the implant has to be removed,� he said.
Hanssen noted that despite the increased use of tissue biopsy to diagnose infection, he discourages its use. Recent data show biopsies are no more accurate than other diagnostic methods and actually can yield more false-positives, he said.
A key factor to consider in treating cases of infection is the infecting organism itself, although good debridement, local delivery of antibiotics and good surgical reconstruction are also important. Debridement is best used during the first month of an acute hemotogenous infection. If it is beyond a month, or if it is not an acute infection, the implant should probably be removed, he said.
For more information:
- Hanssen AD. Infected hip replacement: Prevention, diagnosis and treatment in 2005. Presented at the American Association of Hip and Knee Surgeons Specialty Day. Feb. 26, 2005. Washington.