Rationale

Prosthetic joint infection (PJI) after TKA is among the most frequent indications for revision TKA.¹–⁴ A huge economic burden is associated with the increasing number of (septic) revision TKA.⁵

Clinical comment

One of the most frequent causes for wound contamination is skin microflora. With the incision made during surgery, micro‐organisms may be able to infect tissue, joint, and/or implant. It is a widely accepted fact that the use of an antiseptic skin wash product can reduce skin microflora. However, there is no consensus whether this leads to a reduced incidence of SSI/PJI.⁶,⁷ Knowing the history of the patient, you want to know if bathing/showering with antiseptic skin wash products prior to surgery can help prevent an SSI/PJI.

Available literature and quality of the evidence

• Level III: our literature search showed 1 meta‐analysis (including 4 retrospective comparative studies with 8787 patients) investigating exclusively TKA patients.⁸
  
• Level III: 1 retrospective comparative study including 2055 TKA patients.⁹
  
• Level I: 1 Cochrane systematic review (including 7 randomized controlled trials [RCTs] with 10 157 patients) investigating SSI of all localizations.¹⁰

Findings

The level III meta‐analysis results (total study population) indicate a reduced incidence of SSI when chlorhexidine (the active substance in all investigations) was used in preoperative washing/wiping (risk ratio [RR] = 0.22; 95% confidence interval [CI]: 0.12–0.40; p = 0.000). Furthermore, a reduction of SSI rates in moderate and high risk patients according to the National Healthcare Safety Network (NHSN) risk classification is shown (RR = 0.18; 95% CI: 0.05–0.63; p = 0.007 and RR = 0.13; 95% CI: 0.03–0.67; p = 0.014.⁸,¹¹

In contrast, the level I systematic review as well as the retrospective comparative study found no benefits in the chlorhexidine groups regarding SSI incidences. A discrimination by risk classification has not been performed in these studies. Insignificant differences in SSI rates are reported in the chlorhexidine and in the placebo groups (RR = 0.60; 95% CI: 0.22–1.60; p = 0.330.⁸–¹⁰

Resolution of clinical scenario

• Routine use of preoperative chlorhexidine baths/showers or wipes is not recommended for daily clinical practice as it shows no SSI rate reduction in TKA.⁹,¹⁰
  
• The SSI risk should be calculated if deemed necessary.¹¹
  
• In TKA patients with moderate to high SSI risk profiles chlorhexidine baths/showers or wipes should be considered, especially regarding the low cost and the very rare unwanted side effects. However, the available data do not support a final recommendation.⁸

Rationale

Multidisciplinary perioperative treatment protocols for TKA have been presented and further advanced in recent years, aiming to provide standardized treatment leading to a reduced length of stay, improved clinical outcome, and patient satisfaction.¹²–¹⁴ To achieve this, physicians, anesthesiologists, physiotherapists, and nurses must closely work together and adhere to evidence‐based protocols, known as fast track (or FT).

Clinical comment

Related posts:

The Direct Anterior Approach Patient‐Specific Instrumentation in Total Knee Arthroplasty Management of Glenoid Bone Loss Distal Femur Fractures Periprosthetic Fractures: Knee Lisfranc Injuries

Stay updated, free articles. Join our Telegram channel

Join