Optimization Joint arthroplasty

1. Decolonization MRSA
•Evidence supporting is
strong.
•Efficacy studies needed for
different treatments.
•Cost analysis needed.

2. Nutritional Optimization
Lymphocyte Cnt > 1500
Albumin > 3.5 g/dl
Zinc > 5 mcg/dl
Transferrin > 200 mg/dl

3. High Risk: Increased
Contamination
•Revision
•OR > 150 min
•Prior joint infection

4. High Risk: Decreased
Immunity
•Rheum Arthritis
•Diabetes Mellitis
•Organ Transplant
•Hemophilia

5. Diabetes
DM: 3.43% vs 0.87%
Mraovic et al 2011:
Blood glucose levels before
surgery and POD#1 were
significantly correlated with
infection.

6. Obesity
•Independently assoc c
Infection
•Inceased risk of other
comorbidities
(*diabetes, CV disease)

7. Postoperative Optimization
•Post op antibiotics
•Blood Transfusion
Hematoma and Drainage
•Duration of hospital stay
•Invasive procedures (including
dental)