months later to hopefully make good on his original promise to
restore the joint's natural function.
"Even after all of that, the infection eradication rate is only about
85%, which isn't great," says Scott Sporer, MD, a hip and knee replace-
ment specialist at Rush University Medical Center in Chicago, Ill.
"MRSA infections are a big deal."
To say the least. Thankfully, there are several ways to limit the risk.
1. Smart patient selection
The essential first step to preventing S. aureus infection is identifying
patients who are at increased risk, and managing their risk factors
before they arrive for surgery. Uncontrolled diabetes, history of smok-
ing, kidney disease and obesity make patients more prone to infec-
tion. Diabetes can be improved with diet and medication, smokers
can stop smoking, obese patients can lose weight and blood glucose
levels can be managed on the day of surgery. However, some non-
modifiable risk factors such as liver or kidney disease might preclude
patients from undergoing joint replacement surgery because the pro-
cedure's risks outweigh its potential benefits.
"Patient optimization is probably the most important factor in mini-
mizing the risk of infection," says Gregory Deirmengian, MD, an asso-
ciate professor of orthopedic surgery at the Rothman Orthopaedic
Institute in Philadelphia, Pa. "If a surgeon operates on a patient with
multiple uncontrolled risk factors, no matter what else is done to pre-
vent infection, the cards are already stacked against the case."
2. Nasal decolonization
S. aureus bacteria found in surgical sites often matches that found in
patients' nares. Research has also identified S. aureus in nasal car-
riages as an independent risk factor of S. aureus infection after joint
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