As total joint replacement surgical technology has improved over the past, but a vital part of care — infection prevention methods — have largely remained stagnant.
Ravi Bashyal, MD, director of outpatient hip and knee replacement surgery at Evanston, Ill.-based Endeavor Health, discussed the research he's done in this area on the "Becker's Spine and Orthopedic Podcast."
Note: This is an edited excerpt. Listen to the full conversation here.
Question: Could you give us more insight on redoing your due diligence as a surgeon to reduce the occurrence of some joint infections? How are you looking at this?
Dr. Ravi Bashyal: When we look at modern hip and knee replacement and we look at how we're doing this compared to many years ago, we've improved in a lot of ways. The implants are better. The approaches are better and the technology is better. In the 1970s and 1980s, you would often tell patients the implant might last for 10 or 15 years. The rate of failure was high. But now we're doing outpatient total joint replacements where the patient can go home the same day. We expect the implants to last decades, and we're often using robotics and other advanced technology to put these implants in in a very precise incision. A lot of that has dramatically improved in terms of the technology that we are using to improve those parameters. But when we look at infections, many of the interventions that we use to minimize the risk of infection have stayed the same for many years. That really demonstrates an opportunity for investigation and improvement.
Q: Could you go one bit deeper in terms of improving that and minimizing the rate of infection there?
RB: That's really been the focus of my research. If we look at the major innovations when it comes to preventing infection that have historically been done, it includes use of perioperative antibiotics which we've been doing for decades and decades. It includes sterile technique and minimizing operative time, all things that we've kind of known and done for a long time.
Something that came up to me as interesting was irrigation. When you're doing a surgery, you use irrigation, both for visualization and dilution. As you're doing a surgery, and there's debris that's created, you're going to want to wash that debris away so you can see what you're doing. Traditionally, at the end of the case, you would irrigate at the end to kind of help dilute out the pool to hopefully clean it up and make sure there was no bacteria remaining behind that could lead the joint to become infected. But what struck me is that we've kind of been doing this the same way for decades but with really no significant changes.
Historically, the way that this has been done is that, at the end of the case, you irrigate with a large amount of saline …That sort of has been our standard of care for the past 15 or 20 years. Because that hasn't changed at all, and everything else has, I thought that was a real opportunity to investigate and innovate. That's really where my research has led.