(0.1%)

My rate of early postoperative (within 3 months) deep hip infection is 0.1%. These can usually be cured with aggressive treatment without loosing your implant as long as you keep me informed about problems. If you live out of state and let someone else manage your care, the result may not be as good. For comparison purposes, the national infection rate is 1-2%.

Higher risk patients are those with:

• diabetes
• other immune suppressive conditions
• obesity
• previous hip surgery

I believe our results are superior because we have developed a comprehensive program to prevent infections including the following:

• Preop evaluation
  • No active infection
  • Medical clearance
  • Hg A1c< 7 (if diabetic)
  • normal prealbumin
• Preop Hibiclens shower
• Shave surgical site
• Mupirocin into nostrils
• IV antibiotics for 24º
• Duraprep and plastic adhesive
• Clean air OR + body exhaust suits
• Efficient minimally invasive surgery
• Intraarticular Vancomycin
• Betadine jet lavage irrigation
• Gentamicin loaded cement
• Quill barbed suture closure
• Dermabond (superglue) skin seal
• Acticoat silver dressing (antibacterial) for 7 days
• No dressing changes or wound checks
• Daily mupirocin on incision after acticoat is removed.

Although only some of these measures have been individually proven to decrease infection, we think the combined use of all of them has driven our infection rate more than ten times below the national average.

Most infections in total hip replacements occur either due to contamination at thetime of surgery or from bacteria that invade from the skin through the incision before it is fully sealed within the first few weeks after the operation. It is a myth that surgery can be a truly sterile procedure. The wound also does not become completely sealed for at least one month after surgery. The program works because we address the problem of potential infection from multiple angles: optimize the patient, clean the skin, keep the OR contamination to a minimum, provide antiseptics and antibiotics to kill any residual bacteria, and prevent any bacterial access to the wound postoperatively.

We do not keep track of minor wound problems in a systematic way in our database. I estimate that they occur in less than 5% of patients. Bruising is normal. If you keep me informed about redness, drainage or any wound separation, these can usually be managed without resulting in deep infection.

In the rare case where deep infection occurs, these can usually be cured without loss of implants if treated aggressively with debridement and intraarticular antibiotics.

Late infections (after 3 months) are not directly related to the surgery. Lifetime risk is far less than 1%. Usually the implant has to be removed to cure these. For the rest of your life, cleaning all cuts with an antiseptic like betadine, treating any bodily infections promptly and taking a single dose of preventative antibiotics prior to any invasive procedures as well as prior to teeth cleaning are unproven, but prudent precautions.