Which pairing of perioperative risk and preventive strategy is correct for total joint arthroplasty?

• A. Deep vein thrombosis — avoid pharmacologic prophylaxis to prevent bleeding
• B. Infection — sterile technique, perioperative antibiotics, and minimizing operative time
• C. Dislocation — no specific preventive strategies
• D. Nerve injury — avoid careful dissection

Answer: (B)

In total joint arthroplasty, preventing infection is paramount because a prosthetic infection is extremely difficult to treat and often requires revision surgery. The most effective pairing is sterile technique, perioperative antibiotics, and minimizing operative time. Sterile technique reduces the chance that bacteria contaminate the wound. Perioperative antibiotics provide systemic protection around the time of incision when bacterial exposure is highest. Keeping the operation as efficient as possible limits tissue exposure and edema, both of which can create an environment that supports infection. All three together directly address the pathway by which infection typically establishes itself.

While important, the other options don’t align with best practice. Deliberately skipping pharmacologic prophylaxis to prevent bleeding is not advised, because preventing thromboembolic events is a major goal in joint replacement and pharmacologic prophylaxis is used when not contraindicated, balanced with bleeding risk. For dislocation, preventive strategies include proper implant positioning, soft tissue balancing, and patient precautions—not the claim that there are no specific measures. Nerve injury is best mitigated by meticulous dissection and careful handling of tissues, not by avoiding careful technique.