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.
Anesthetized patients lose the ability to control their own temperature, which typically results in a significant drop in core temperature in the first 30 minutes after anesthesia is administered. Hypothermia has been linked to increased wound infections, increased blood loss, longer recovery time, and higher mortality rates. (>Why Warm)
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.
The most common patient warming method is forced-air. These systems blow hot air on the patient.
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 periprosthetic joint infection (PJI) is an infection deep in the joint, not just a superficial infection at the incision. A PJI cannot be treated with antibiotics alone; it frequently requires explantation of the joint, IV antibiotics, prolonged hospitalization, and multiple revision surgeries—sometimes amputation. Even if amputation is not required, patients report a severely diminished quality of life, including chronic pain (http://stopsurgicalinfections.org/pji.php). The national PJI rate is 1-2%.
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).
Don’t surgical teams do all they can to ensure good air quality? Research points to forced-air warming systems. Five studies have shown that waste heat from forced-air warming contaminates the sterile surgical field with bacteria from the floor. A full research summary can be viewed here. (M206 Research Summary)
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).
The news about these lawsuits is all over the Internet. See for yourself—just Google “Bair Hugger infections” (Bair Hugger, manufactured by 3M, is the leading forced-air system). Your search will yield over 100 websites of law firms that are advertising for injured joint implant patients. Some of these firms are also advertising on TV.
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)
Change comes very slowly in the healthcare field. The choice of patient warming method is up to each hospital. So far, there hasn’t been a recall of forced-air warming, or any regulatory action by the FDA.
Ask your doctors if they’re aware of the risks of forced-air warming. Tell them you’ve done your own research and that you are concerned about the risks.
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?)