The Orthobullets Podcast Podiums | Trauma | My Steps to Try and Avoid Infection
Jan 4, 2026
In this insightful discussion, Dr. Evan Lederman, an orthopedic surgeon specializing in shoulders, shares his expertise on preventing surgical infections. He reveals the surprising infection rates and key organisms like C. acnes involved in shoulder arthroplasty. Lederman addresses modifiable risk factors, such as diabetes and smoking, and emphasizes preoperative decolonization techniques. His practical tips include antibiotic strategies and optimizing operating room setups to enhance patient safety. Infection control, he stresses, requires collaboration across medical teams.
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Shoulder Replacement Infection Risk Is Significant
- Shoulder replacements carry substantial infection risk, with reverse designs ~3%/yr and anatomic ~1%/yr. Evan Lederman emphasizes that infection prevention requires coordinated effort across surgeons, patients, and primary care.
Optimize Host Factors Preoperatively
- Optimize modifiable host factors before surgery, including delaying cases after corticosteroid injections and controlling diabetes. Avoid elective replacement in poorly controlled diabetics or recently injected shoulders when possible.
Decolonize Skin With Benzoyl Peroxide And CHG
- Use targeted decolonization to lower bacterial burden: benzoyl peroxide for C. acnes and chlorhexidine wipes for staph. Apply benzoyl peroxide twice daily to the shoulder for three days and do full-body chlorhexidine wipes preoperatively.