The talk
Dr Cutbush presented a talk on preventing infection in large joint arthroplasty, at a session on infection in arthroplasty held by the Prince Charles Hospital Orthopaedic Department.
Departmental meetings of this kind are where practice within a unit is reviewed and standardised, which is the level at which infection prevention protocols actually get implemented.
What arthroplasty is
Arthroplasty is the surgical replacement of a worn joint surface with an implant. In large joint arthroplasty, meaning the hip, the knee and the shoulder, the damaged surfaces are removed and replaced with metal, plastic or ceramic components. It is among the more commonly performed operations in orthopaedics and is generally undertaken for arthritis that has not settled with other measures. Individual results vary, and whether a joint replacement is appropriate for any one patient depends on their symptoms, their imaging and their circumstances.
Why infection is the central concern
Infection around an implant is a different problem from infection in ordinary tissue. Bacteria can form a biofilm on the surface of an implant, a layer within which they are far less accessible both to antibiotics and to the body's own defences. Once that has become established, treatment usually means further surgery rather than antibiotics alone, and it may mean removing and replacing the implant in one or two stages.
The consequences for the patient are considerable, and the treatment is long. That is the reason so much of the attention in arthroplasty goes into prevention rather than into the management of infection after the event.
What prevention involves
- Preparation of the patient before surgery, including skin preparation and the management of other conditions that affect healing.
- Antibiotics given at the correct time relative to the incision.
- Theatre discipline: airflow, the number of people in the room, traffic through the doors and the handling of instruments.
- Careful handling of tissue during the operation, and keeping operating time to what the case genuinely requires.
- Wound management and monitoring in the weeks afterwards.
None of these is dramatic on its own, and that is rather the point of a departmental session. They work as a set, and a set only becomes reliable when a whole unit does the same thing every time, rather than each surgeon following a personal version of it.
Related information
For patients, our post on preventing infection in shoulder replacement surgery covers this subject in accessible terms. See also our anatomic total shoulder replacement, reverse total shoulder replacement and surgery FAQs pages.