Perioperative optimization of comorbidities to enhance wound healing in total joint arthroplasty

Total joint arthroplasty is a successful operation to relieve pain and can tremendously improve quality of life. However, total joint arthroplasty can have devastating complications including infection. Therefore, attention has been placed on methods to reduce the risk of infection after these operations. This article reviews evidence-based methods of perioperative optimization to achieve successful wound healing, and to avoid subsequent periprosthetic joint infection after total hip and total knee arthroplasty. Preoperative considerations include the host-healing ability as described by Cierny. Factors that contribute to this are obesity, nutritional status, control of diabetes mellitus, immunosuppression, smoking status, anemia, and bacterial colonization. Postoperative considerations include the method of venous thromboembolism prevention, recognition of a problem wound, and prompt treatment to minimize the risk of subsequent infection.