Depilation and Skin Preparation to Prevent an Infected Total Knee Arthroplasty

© Springer International Publishing AG 2018
E. Carlos Rodríguez-Merchán and Sam Oussedik (eds.)The Infected Total Knee Arthroplasty

4. Depilation and Skin Preparation to Prevent an Infected Total Knee Arthroplasty

Carlos Kalbakdij-Sánchez , Gregorio Arroyo-Salcedo  and E. Carlos Rodríguez-Merchán 

Department of Orthopaedic Surgery, “La Paz” University Hospital-IdiPaz, Paseo de la Castellana 261, 28046 Madrid, Spain



Carlos Kalbakdij-Sánchez


Gregorio Arroyo-Salcedo


E. Carlos Rodríguez-Merchán (Corresponding author)


Depilation and skin preparation before total knee arthroplasty (TKA) and any other surgery are well known but frequently underestimated as a potential source of contamination. The patient’s skin is a major source of pathogens that may cause surgical site infection. Optimizing the methods employed may reduce the burden of infections.

Total knee arthroplastyInfectionSkin preparationDepilation

4.1 Introduction

Skin care and depilation before total knee arthroplasty (TKA) should be considered one of the key steps in clinical guidelines for lower-limb arthroplasty. There are many questions and considerations that we have to review before a surgical incision.

One question is when to perform preoperative hair removal (PHR). Many authors consider that there is no difference in complications whether this occurs the evening before or the same day as the surgery [1] and neither does the method appear important—shaving, clipping, or chemical depilation.

Common sense and the evidence support that if there is hair in the surgical site, depilation should be performed [1].

The Cochrane review of 2011 about skin care and depilation arises from the idea that traditionally preparation included removal of hair from the incision site, but some studies claim that PHR is harmful, causes surgical site infections (SSIs), and should be avoided.

The purpose of this chapter is to review the literature in order to know if we can optimize preoperative skin preparation.

4.2 General Recommendations

  • Patients should take a bath or shower before surgery with either soap or an antiseptic solution.

  • Hair at the surgical site should be removed only when the hair interferes with the surgical procedure.

  • Safe effective preoperative antiseptics should be selected for the individual patient.

4.3 Preoperative Hair Removal (PHR): Shaving, Clipping, or Depilatory Creams

During the process of shaving, the skin may experience microscopic cuts and abrasions. It is believed that saprophytic skin flora is able to enter and colonize these cuts, therefore contaminating the surgical incision site leading to SSIs and potentially to periprosthetic joint infections (PJI) [1].

It is important to remember that PHR should not take place in the operating room because this may contaminate the sterile surgical field [2].

Another important recommendation is that PHR should be carried out by skilled personnel in order to prevent abrasion injuries.

The Centers for Disease Control (CDC) strongly recommends that PHR should not be performed unless the hair at or around the incision site will interfere with the surgery [1].

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Mar 10, 2018 | Posted by in ORTHOPEDIC | Comments Off on Depilation and Skin Preparation to Prevent an Infected Total Knee Arthroplasty

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