Articles | Volume 11, issue 3
https://doi.org/10.5194/jbji-11-299-2026
https://doi.org/10.5194/jbji-11-299-2026
Review
 | 
22 May 2026
Review |  | 22 May 2026

Nasal decolonization in total joint arthroplasty: current state of evidence

Andrea Zampoli, Ghazal Pourbozorg, Goksel Dikmen, Ibrahim Tuncay, and Javad Parvizi

Cited articles

Abolghasemi, S., Ghazi, M., Ziaie, S., Mahboubi, A., Gachkar, L., Keyvanfar, A., and Naeimipoor, M.: Comparison of the Efficacy of Povidone-Iodine with Mupirocin in Decolonizing Staphylococcus aureus from the Nasal Cavity of Healthcare Workers: A Single-Blinded Randomized Controlled Trial, Infect. Disord. Drug Targets, 25, e18715265301671, https://doi.org/10.2174/0118715265301671240910070901, 2025. 
Anderson, M. J., David, M. L., Scholz, M., Bull, S. J., Morse, D., Hulse-Stevens, M., and Peterson, M. L.: Efficacy of Skin and Nasal Povidone-Iodine Preparation against Mupirocin-Resistant Methicillin-Resistant Staphylococcus aureus and S. aureus within the Anterior Nares, Antimicrob. Agents Ch., 59, 2765–2773, https://doi.org/10.1128/AAC.04624-14, 2015. 
Baede, V. O., Barray, A., Tavakol, M., Lina, G., Vos, M. C., and Rasigade, J.-P.: Nasal microbiome disruption and recovery after mupirocin treatment in Staphylococcus aureus carriers and noncarriers, Sci. Rep., 12, 19738, https://doi.org/10.1038/s41598-022-21453-4, 2022. 
Bianco Prevot, L., Tansini, L., Riccardo, A., Bolcato, V., Tronconi, L. P., and Basile, G.: Cutting Periprosthetic Infection Rate: Staphylococcus aureus Decolonization as a Mandatory Procedure in Preoperative Knee and Hip Replacement Care – Insights from a Systematic Review and Meta-Analysis of More Than 50,000 Patients, J. Clin. Med., 13, 4197, https://doi.org/10.3390/jcm13144197, 2024. 
Bostian, P. A., Vaida, J., Brooks, W. C., Chaharbakhshi, E., Dietz, M. J., Klein, A. E., Murphy, T. R., Frye, B. M., and Lindsey, B. A.: A Novel Protocol for Nasal Decolonization Using Prolonged Application of an Alcohol-Based Nasal Antiseptic Reduces Surgical Site Infections in Total Joint Arthroplasty Patients: A Retrospective Cohort Study, Surg. Infect. (Larchmt), 24, 651–656, https://doi.org/10.1089/sur.2022.344, 2023. 
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Short summary
Staphylococcus aureus nasal colonization is a key contributor to postoperative infection after hip and knee replacement. We review current evidence on screening and nasal decolonization, highlighting that reliable decolonization is more critical than screening alone. We summarize practical treatment options and propose a simple, standardized preoperative protocol that can be implemented in routine arthroplasty pathways to reduce preventable infections.
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