Triple prophylaxis for the prevention of surgical site infections in total joint arthroplasty

Background: Surgical site infection is a devastating complication and the most common mode of failure in total joint arthroplasty (TJA). The purpose of this study was to evaluate a unique triple prophylaxis protocol (preoperative nasal application of mupirocin, preoperative intravenous administration of vancomycin, and intraoperative betadine irrigation) in reducing surgical site infection rates in TJA. Methods: Our sample included 1034 consecutive patients who underwent primary hip or knee TJA for degenerative joint disease in the 2 yr prior to (control group) and 2 yr after institution of this protocol (treatment group). After follow-up of a minimum of 1 yr, we identified all patients who developed surgical site infection. We then calculated and compared the overall, superficial, deep, and methacillin-resistant Staphylococcus aureus (MRSA) surgical site infection rates between the control and treatment groups. Results: The overall surgical site infection rate decreased from 2.0% in our control cohort to 0.7% ( P =0.08) in our treatment cohort. Rates of deep surgical site infection significantly decreased from 1.4% to 0.2% ( P =0.02), but no change was observed in rates of superficial surgical site infection (0.6% to 0.6%, P =0.92). The rate of MRSA infection decreased from 0.6% to 0.2%, but this was not significant ( P =0.28). Conclusions: We discovered that using this three-pronged prophylaxis approach for primary total knee and hip arthroplasties significantly decreased the rates of deep SSI compared to patients who did not receive these interventions. This protocol has the potential for changing the current protocol for preventing surgical site infection in future TJA.