Resources for Patients
Are you considering hip or knee replacement surgery, or any type of implant surgery? Make sure you have the information to protect yourself. The fact that you’re reading this is a good start!
Once your joint replacement is scheduled, your doctor and nurses will provide resources to help you prepare for a successful surgery and post-operative recovery; following their instructions is critical. Nevertheless, the modern healthcare system requires patients to be their own advocates.
A critical issue is the type of patient warming system used on you. This decision could have an impact on your surgical outcomes.
Ask your doctor about air-free patient warming.
Active patient warming is the worldwide standard of care for surgical patients, especially those undergoing procedures longer than 60 minutes. Forced-air warming, however, has been linked to increased infections in orthopedic implant surgery.
Unfortunately, forced-air warming produces a substantial amount of “waste heat.” Forced-air warming systems blow 1000 watts of heat, yet less than 100 watts are actually transferred to the patient. The remaining 900+ watts of “waste heat” are released into the operating room. This air exits near the contaminated floor, forms convection currents, and rises into the operative field, potentially carrying pathogenic organisms with it.
Clean air is critical in orthopedic operating rooms. Surgical teams strictly adhere to best practices to reduce contamination in the air, thereby reducing the risk of infection. Joint-replacement patients are especially vulnerable to infections because when foreign material is implanted in the body, the risk of infection increases. It takes over 100,000 germs to cause a soft-tissue surgical infection, but a single germ can cause a devastating periprosthetic joint infection (PJI). Why? The germ can secrete a coating of biofilm (http://stopsurgicalinfections.org/resources.php) that protects it from both antibodies and antibiotics. Bacteria in soft-tissue cannot form effective biofilm coatings (http://stopsurgicalinfections.org/pji.php).
A well-known patient advocate, Rosie Bartel, was infected with MRSA during a knee replacement procedure at a hospital using forced-air warming. Bartel has undergone 27 subsequent operations, including amputation of her leg to the hip. Bartel reviewed research to find out how pathogens from the floor of the operating room could rise up into the sterile field and end up in her open wound. Visit her website to see what she learned, and what advice she now gives to patients: (http://www.rosiesdream.com/for-patients.html).
One of the studies found a 74% reduction in deep joint infection rates after discontinuing forced-air warming. Authors McGovern and Reed found, “Excess heat from forced air warming resulted in the disruption of ventilation airflows over the surgical site.” See the study abstract here (M206 Research Summary).
Another study found 2,000 times more contaminant particles in the air over the wound when forced-air warming was used versus air-free conductive fabric warming (M206 Research Summary).
Product-liability lawsuits have been filed against 3M, alleging their product, Bair Hugger, caused deep joint infections.
The Plaintiffs assert that 3M has known of the risks of Bair Hugger for years, yet continued to market the product and “intentionally mislead” healthcare providers, assuring them of its safety. (http://www.reuters.com/article/2015/08/26/products-bairhugger-lawsuits-idUSL1N1110L020150826)
It’s important that you’re actively warmed during surgery: complications from hypothermia are significant. Ask your doctor about air-free warming alternatives. HotDog’s air-free technology provides all the benefits of normothermia without the risks of forced-air. (>Why HotDog?)