Why Infection Rates Are So Low

One of the most devastating complications in hip replacement surgery is a deep infection. With the anterior hip replacement approach the hip is fairly well protected and infections are rarely seen. This is because muscle lives directly under the incision. Muscle has high blood flow and is protective. Even if the skin itself develops an infection or a small leak, treatment is successful. Knee replacement patients have always been at a slightly higher risk for infection. There are numerous reasons for this, but one of them is that there is no muscle under the skin incision of a new replacement.

We are passionate defenders against infections. Attention to these details has made postoperative wound infections a rare event in the delivery of hip and knee replacement surgery. Our commitment to earnestly doing all we can to prevent infection is our unflagging commitment to you. As such, numerous precautions are taken:

1. Patients are asked to shower prior to surgery with an antimicrobial soap.

2. Body hair near and at the incision site is carefully removed in the pre-op area.

3. A body weight adjusted, preoperative IV antibiotic is given and must be fully administered at least five minutes prior to making an incision.

4. The skin is carefully sterilized with a prepping agent and allowed to dry.

5. A Betadine or Iodine based bio drape is applied to the dry skin protecting the wound from bacteria.

6. Immediately after a skin incision is made, the deeper tissues are cleansed with Betadine to prevent any bacteria in hair follicles from entering the wound.

7. All retraction is done as carefully as possible with three gentle edged retractors to protect the skin and underlying tissues. We avoid unnecessarily damaging tissue; damaged tissues have a higher infection rate.

8. Speed and skipping steps is not part of quality surgery; however, efficiencies in technique and all surgical team members knowing and anticipating each step can decrease surgical time. Decreasing the number of minutes the wound is exposed to the outside world diminishes infection rates.

9. All team members wear the equivalent of a hazmat suit to protect any body hair, cells, or respiratory droplets from entering the wound.

10. The number of patients entering the operating room is kept to a minimum to keep the bacteria in the air at a low count.

11. After implanting the artificial joint, the wound is irrigated with a pulsed lavage, a form of mechanical hydrotherapy that uses a pressurized, pulsed solution to irrigate the wound.

12. The wound is then soaked in a diluted Betadine solution, further killing any potential bacteria in the wound.

13. Suture technique is designed to be gentle to the soft tissues. Appropriate margins and tension are gauged where layers of the skin can heal, but not so tight as to strangulate, thereby decreasing blood flow. Gentle technique provides for healthier wound healing.

14. A medical grade, waterproof, super glue and mesh skin closure system completes the process.

15. All patients are encouraged to rest for the first 72 hours and apply ice periodically to allow the wound to seal. This rest also allows for minimal bleeding and swelling at the incision site. Wounds that are afforded this time window experience lower infection rates.