Bunion Surgery Can Proceed Without Evidence of Infection
Yes, bunion surgery can and should proceed when there is no evidence of infection present. The absence of infection is actually the ideal condition for elective orthopedic procedures like bunion surgery, as it minimizes surgical site infection risk and optimizes outcomes.
Preoperative Assessment for Infection
When evaluating a patient for bunion surgery, you should specifically assess for:
- Local signs of infection: erythema, warmth, purulent drainage, or fluctuance around the bunion or metatarsophalangeal joint 1
- Systemic signs: fever, elevated white blood cell count, or signs of sepsis 2
- Skin integrity: open wounds, ulcerations, or breaks in the skin barrier that could harbor bacteria 2
The absence of these findings indicates the patient is an appropriate surgical candidate from an infectious standpoint 3.
Antibiotic Prophylaxis Strategy
For clean orthopedic procedures like bunion surgery without evidence of infection, prophylactic antibiotics should be administered as a single preoperative dose, not continued postoperatively 2, 3.
Recommended Prophylaxis Protocol:
- Agent: Cefazolin 2-4g IV (or cefuroxime 1.5-3g IV) 2
- Timing: 30 minutes before incision 2, 3
- Re-dosing: Only if surgery duration exceeds 4 hours for cefazolin (2 hours for cefuroxime) 2
- Duration: Single dose only; discontinue within 24 hours 2
For patients with beta-lactam allergy, vancomycin 15-30 mg/kg IV over 120 minutes is appropriate 2.
When Surgery Should Be Delayed
Surgery should be postponed if any of the following are present:
- Active soft tissue infection around the surgical site 2
- Systemic infection or sepsis 2
- Open wounds or skin breakdown over the bunion 2
- Recent cellulitis that has not fully resolved 2
Important Clinical Caveats
Smoking is a relative contraindication to bunion surgery due to increased infection and healing complications; cessation is strongly recommended before proceeding 1.
Cosmesis alone is not an indication for bunion surgery—patients should have symptomatic bunions causing pain or functional impairment that has failed conservative management 1.
The standard of care is to perform bunion surgery in a clean, infection-free environment with appropriate single-dose antibiotic prophylaxis 2, 3. Prolonged antibiotic courses are not indicated and contribute to resistance without improving outcomes 2.