Nasal decolonization in total joint arthroplasty: current state of evidence

Periprosthetic joint infection is a major cause of morbidity and economic cost after total joint arthroplasty, with Staphylococcus aureus consistently identified as the most common pathogen causing surgical site infection (SSI) and periprosthetic joint infections (PJIs). Nasal mucosa is one of the principle reservoirs for S. aureus. Molecular epidemiology investigations have found concordance between nasal organisms and infecting strains, implying that many postoperative infections arise endogenously. Over the last decade, various clinical trials, institutional protocols, and meta-analyses have evaluated the efficacy of nasal screening and decolonization of Staph aureus. Recent evidence suggests that the success of infection prevention procedures is dependent on the reliability and consistency of decolonization rather than screening alone. This narrative review summarizes current evidence on nasal decolonization in total joint arthroplasty, including epidemiological data, methods of screening, and accessible therapy choices to suggest practical and reproducible infection control measures.