Specific considerations for joint arthroplasty

Staphylococcus aureus colonisation increases the risk of postoperative arthroplasty device infection (prosthetic joint infection). Screen patients before arthroplasty procedures for S. aureus carriage (both methicillin-susceptible and methicillin-resistant strains). If the results of screening are positive, perform decolonisation.

Treating asymptomatic bacteriuria before arthroplasty procedures does not reduce the risk of postoperative prosthetic joint infection. Therefore, do not screen for or treat asymptomatic bacteriuria before prosthetic joint replacement surgery.

Perioperative use of urinary catheters is common in arthroplasty procedures. Do not administer an antibiotic (eg gentamicin) at the time of catheter insertion or removal, or continue antibiotic prophylaxis until catheter removal. These practices are not supported by evidence and may cause adverse effects.

The use of antimicrobial-impregnated cement for fixation of the prosthetic device is a common practice. High-quality data to support the efficacy and cost-effectiveness of this practice are limited.