title: Wound Hygiene Practices After Total Knee Arthroplasty: Does It Matter?
abstract: Current literature is limited with regard to standardized postoperative surgical site hygiene after total knee arthroplasty (TKA). With little guidance from the literature, the timing of permissible postoperative cleaning is a decision made by the individual surgeon using anecdotal evidence. A standardized wound care regimen is of particular interest to minimize the risk of infection.
  
  
  
  To examine what species of bacteria recolonize the surgical site postoperatively, a randomized controlled trial was performed of 16 TKA patients who were allowed to shower at 2 days postoperatively and of 16 patients who were asked to wait until 2 weeks postoperatively before showering after TKA. Culture swabs of skin adjacent to the incision were performed preoperatively, just after incision closure, at dressing removal, and at 2 weeks postoperatively. Bacteria were speciated and compared between groups. A swab of the contralateral knee was performed at 2 weeks as a control. A survey of patient's preference regarding early and late showering was also carried out.
  
  
  
  No difference was found between the groups in rate of colonization or bacterial type, and no patients developed infection. Patients overwhelmingly preferred early showering rather than late (P = .28-.99).
  
  
  
  There is no difference in surgical site bacterial recolonization between early and delayed showering after primary TKA.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, IL.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Yu
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, IL.
authors.forename: David C
authors.initials: DC
authors.lastname: Alfieri
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, IL.
authors.forename: Kristen N
authors.initials: KN
authors.lastname: Bartucci
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, IL.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Holzmeister
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, IL.
authors.forename: Harold W
authors.initials: HW
authors.lastname: Rees
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006920:Hygiene / Q000592:standards*; D017053:Infection Control; D007719:Knee Joint; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012867:Skin / Q000382:microbiology*; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors
keywords: TKA; incision care; perioperative protocols; primary knee arthroplasty; showering