Decolonization of drug-resistant organisms before total joint arthroplasty.

Periprosthetic joint infection is now the leading cause of failure after a total knee arthroplasty, and Staphylococcus aureus, most commonly from the patient's own flora, typically is the infective agent. Several preoperative screening tests have been developed to identify patients who are carrying methicillin-resistant S aureus. Testing and decolonization programs have generally been effective in decreasing the incidence of surgical site infections, but the role of such programs in total joint arthroplasty has not been thoroughly investigated. Although recent studies found a tendency toward fewer methicillin-resistant S aureus infections after total joint arthroplasty when a testing and decolonization program was used, most of these studies were underpowered. Larger, randomized, controlled studies are needed.