Preventing Infection in Shoulder Replacement Surgery.
Infection is a rare but serious complication of shoulder arthroplasty surgery. In the rare circumstance where infection does occur the shoulder prosthesis may need to be removed and a new replacement surgery performed after treatment with high dose antibiotics. Dr Cutbush’s rate of infection for patients undergoing shoulder replacement is very low being well under 1%.
Beyond meticulous surgical technique and obsession with surgical sterility Dr Cutbush prepares his patients for joint replacement surgery utilising a fastidious preoperative programme based on the latest scientific research available.
All patients are seen by an experienced Physician prior to surgery to ensure that all medical issues are identified and their treatment optimised. You will have blood tests performed to check the health of your major organ systems and to ensure that you don’t have a low red blood cell count (anaemia). In the uncommon circumstance where a patient does have anaemia this will need to be corrected prior to surgery to reduce the risk of infection and the possible need for blood transfusion. This approach of having all patients undergo a medical check up before undergoing joint replacement surgery has been shown to reduce the rate of complications of surgery including the potential risk of infection. It has also been shown to be cost effective. Prominent medical societies now recommend this approach.
When you are listed for shoulder replacement surgery Dr Cutbush’s staff will give you several surgical scrub brushes. You will be asked to shower using these surgical scrub brushes containing hospital grade disinfectant for the two nights prior to coming in to hospital for surgery. Washing your whole body with a hospital scrub dramatically reduces the amount of bacteria present on your skin and the risk of bacteria contaminating your surgery.
Dr Cutbush’s staff will give you a script for mupiricin nasal ointment. This is an antibiotic ointment that you will be asked to apply to both your nostrils twice a day for five days prior to surgery.
There is now compelling scientific evidence that approximately 70 to 80% of Staphylococcal aureus (Golden staph) wound or blood borne infections are genetically identical to bacteria harboured in the nose of patients that contract these infections. Studies have shown approximately 80% of people harbour Staphylococcal bacteria in their nose from time to time. Testing has shown that at any one time 30% of people are carrying these bacteria in their nasal passages without being aware they are. Swab testing can be performed to check whether these bacteria are present, however, the tests are unreliable and only identify half of the people carrying the bacteria.
Mupiricin ointment is very effective at eradicating the bacteria from the nose and nasal passages. Studies have shown that eliminating the bacteria from the nose has the added flow on effect of eliminating these bacteria from a patient’s axilla and groin regions where these bacteria can also be found.
Eradicating the Staphylococcal bacteria from a patient’s body prior to surgery is believed to reduce the risk of Staphylococcal infection by 70 to 80%.
At the time of booking your surgery you will be asked to purchase benzoyl peroxide 5% ointment from the chemist. You will be asked to apply this ointment to the skin of your shoulder region and axilla twice a day for two days before surgery, including the morning of surgery.
The commonest bacteria that can affect shoulder surgery is different to that for hip or knee operations. In the shoulder Propionibacterium acnes (P. acnes) is the most common bacteria that causes problems. This particular bacteria lives in the pores and hair follicles in the skin of your shoulder, neck and head region.
Benzoyl peroxide has been demonstrated to eliminate the P. acnes bacteria from patient’s skin when used prior to undergoing surgery thereby dramatically reducing the potential risk of this bacteria causing a surgical infection.
Benzoyl peroxide is not an antibiotic. It is a simple, and common acne cream. It can bleach clothes so it is recommended that it is washed off 30 minutes after being applied.
At the hospital you will have an intravenous cannula inserted into one of your veins well before your surgery and prophylactic antibiotics will be administered intravenously through a drip prior to your joint replacement surgery so that the antibiotic levels in your blood stream are at a suitably high level before Dr Cutbush commences your operation.
Is there anything you can do to help reduce the risk of a complication occurring when you have surgery?
There is. Please contact Dr Cutbush’s office if you develop any abscess of skin ulceration or even if you find a whitehead type pimple on your skin in the region of your planned surgery. Also let the office know if you develop a chest infection of other illness prior to surgery. In most instances your surgery will need to be delayed until you make a full recovery.
Dr Cutbush has spoken at several medical conferences in Australia and overseas on the topic of preventing infection in shoulder replacement surgery. Dr Cutbush was invited to speak on this issue at the New Zealand Shoulder Society meeting in Queenstown in July 2017 and most recently spoke on this subject at the Japanese Shoulder Society meeting in Tokyo in October 2017.
Dr Cutbiush speaking in Tokyo at the Japanese Shoulder Society Meeting