The 7-Day Protocol That Slashed Total Joint Infection Rates by 66%

Unpacking the data that shows why outcome-based reimbursement models shouldn't force surgeons to deny care to high-risk patients based on BMI or diabetes.

Periprosthetic joint infection (PJI) is one of the most dreaded complications after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). While the PJI rate remains at 1%-2% after primary TJA, high-risk patients (patients with known risk factors) have been shown to have increased susceptibility to infection. The current literature is replete with research from the past decade on surgical and host factors associated with PJI, particularly modifiable risk factors for prevention of infection. Accordingly, most surgeons and institutions have adopted key prevention protocols to minimize postoperative infection.

However, host factors can be notoriously difficult to manage. Furthermore, the 2017 CDC guidelines recommended against the continuation of antibiotics postoperatively (after incision closure) after TJA; this is concerning because the guidelines are based on only 6 orthopedic studies, 5 of which were published before 1991, and only 2 of which were TJA-related. Data from other surgical specialties should not be extrapolated to orthopedic surgery, particularly when hardware is involved, which has a high predilection for biofilm formation.