Preoperative optimization to prevent periprosthetic joint infection in at-risk patients

Periprosthetic joint infection (PJI) remains an important complication with devastating consequences after total joint arthroplasties. With the increasing number of arthroplasties worldwide, the number of PJI will increase correspondingly with a significant economic burden to our healthcare system. It is likely impossible to completely eradicate PJI; hence, assessment and optimization of its risk factors to preventing such a disastrous complication will be the key. There are many strategies to prevent PJI in the preoperative, intraoperative, or postoperative phases. The preoperative assessment provides a unique opportunity to screen and diagnose underlying comorbidities and optimize modifiable risk factors before elective surgeries. In this review, we will focus on current literature in preoperative assessment of various modifiable risk factors and share the experience and practical approach in our institution in preoperative optimization to reduce PJI in total joint arthroplasties.

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Identification and preoperative optimization of risk factors to prevent periprosthetic joint infection

World Journal of Orthopedics ◽

10.5312/wjo.v5.i3.362 ◽

2014 ◽

Vol 5 (3) ◽

pp. 362 ◽

Cited By ~ 28

Author(s):

Seung-Hoon Baek

Keyword(s):

Risk Factors ◽

Periprosthetic Joint Infection ◽

Joint Infection ◽

Preoperative Optimization

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Perioperative prognosis of infectious complications after total hip and knee arthroplasties. Part I

Genij Ortopedii ◽

10.18019/1028-4427-2021-27-5-636-644 ◽

2021 ◽

Vol 27 (5) ◽

pp. 363-644

Author(s):

S.V. Braginа ◽

◽

V.P. Moskalev ◽

A.L. Petrushin ◽

P.A. Berezin ◽

...

Keyword(s):

Risk Factors ◽

Joint Infection ◽

Perioperative Period ◽

Infectious Complications ◽

Current Status ◽

Excess Body Weight ◽

Modifiable Risk Factors ◽

Total Hip ◽

Duration Of Surgery ◽

Joint Arthroplasties

Abstract. Introduction The number of total joint arthroplasties performed globally has increased over time, and the projected growth for total knee arthroplasty (TKA) and total hip arthroplasty (THA) in 2030-2050 is associated with an increase in the number of surgical complications, such as periprosthetic joint infection (PJI). Perioperative modifiable risk factors can be altered to help improve rates of the devastating scenario. The purpose of the review was to systematize information on modifiable risk factors for PJI after THA and TKA and the ways to improve them. Material and methods Scientific literature search was performed via web-based services of PubMed, eLibrary, Scopus, Dimensions. The search depth was 30 years. Results Modifiable risk factors were shown to be associated with the patient's condition, medical history, current status, intraoperative and postoperative surgical options. Well-established modifiable risk factors include tobacco use, alcohol consumption, excess body weight, obesity, malnutrition, duration of surgery, postoperative wound hematoma. Discussion Timely diagnosed modifiable risk factors for PJI can be improved at the preparation stage, perioperatively and postoperatively. The interaction of inpatient and outpatient hospital services in the perioperative period is essential for reducing the risk of PJI after THA and TKA.

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Risk Factor Analysis for Above-knee Amputation in Patients With Periprosthetic Joint Infection of the Knee: a Case-control Study

10.21203/rs.3.rs-440521/v1 ◽

2021 ◽

Author(s):

Franziska Eckers ◽

Christoph J. Laux ◽

Sebastian Schaller ◽

Martin Berli ◽

Yvonne Achermann ◽

...

Keyword(s):

Risk Factors ◽

Alcohol Abuse ◽

Periprosthetic Joint Infection ◽

Case Control Study ◽

Joint Infection ◽

Case Control ◽

Individual Risk ◽

Preoperative Anemia ◽

Knee Amputation ◽

Control Study

Abstract Background: Periprosthetic joint infection (PJI) is a severe complication following knee arthroplasty. Therapeutic strategies comprise a combination of surgical and antibiotic treatment modalities and aim to eradicate the infection. Sometimes control of the disease can only be attained by above-knee amputation (AKA). While a vast amount of literature exists illuminating predisposing factors for PJI, risk factors favoring the endpoint AKA in this context are sparsely known. Methods: The purpose of this investigation was to delineate whether patients with PJI of the knee present specific risk factors for AKA. In a retrospective case-control study 11 cases of PJI treated with AKA were juxtaposed to 57 cases treated with limb salvage (LS). The minimum follow-up was two years. Comorbidities, signs and symptoms of the current infection, factors related to previous surgeries and the implant, microbiology, as well as therapy related factors were recorded. Comparative analysis was performed using student’s t-test, chi-square test or Fisher’s exact test. Binary differences were calculated using odds ratio (OR). Reoperation frequency was compared using Mann-Whitney U test. In-depth descriptive analysis of 11 amputees was carried out. Results: A total of 68 cases aged 71±11.2 years were examined, hereof 11 with AKA and 57 with LS. Severe comorbidities (p=0.009), alcohol abuse (p=0.015), and preoperative anemia (p=0.022) were more frequently associated with AKA. Preoperative anemia was found in all 11 amputees (100%) and in 33 of 57 LS patients (58%) with an average preoperative hemoglobin of 99.9±15.1 g/dl compared to 118.2±19.9 g/dl (p=0.011). No other parameters differed significantly. AKA patients underwent a median of eight (range 2-24) reoperations, LS patients a median of five (range 2-15).Conclusion: Factors potentially influencing the outcome of knee PJI are diverse. The indication of AKA in this context remains a rarity and a case-by-case decision. Patient-intrinsic systemic factors such as alcohol abuse, severe comorbidities and preoperative anemia may elevate the individual risk for AKA in the setting of PJI. We recommend that anemia, being a condition well amenable to therapeutic measures, should be given special consideration in management of PJI patients. Trial registration: This study was registered with Kantonale Ethikkommission Zürich, (BASEC-No. 2016-01048).

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Meta-analysis in periprosthetic joint infection: a global bibliometric analysis

10.21203/rs.3.rs-18525/v1 ◽

2020 ◽

Author(s):

Cheng Li ◽

Cristina Ojeda Thies ◽

Chi Xu ◽

Andrej Trampuz

Keyword(s):

Risk Factors ◽

Bibliometric Analysis ◽

Periprosthetic Joint Infection ◽

Clinical Medicine ◽

Meta Analysis ◽

Joint Infection ◽

Relevant Literature ◽

The United States ◽

Steroid Injections ◽

Joint Replacement Surgery

Abstract Background: Periprosthetic joint infection (PJI) is the most serious complication of joint replacement surgery. Further comorbidities include bedsore, deep vein thrombosis, reinfection, or even death. An increasing number of researchers are focusing on this challenging complication. The aim of the present study was to estimate global PJI research based on bibliometrics from meta-analysis studies. Methods: A database search was performed in PubMed, Scopus, and Web of Science. Relevant studies were assessed using the bibliometric analysis. Results: A total of 117 articles were included. The most relevant literature on PJI was found on Scopus. China made the highest contributions to global research, followed by the United States and the United Kingdom. The institution with the most contributions from the University of Bristol. The journal with the highest number of publications was The Journal of Arthroplasty, whereas the Journal of Clinical Medicine had the shortest acceptance time. The day of the week with the greatest number of received and accepted manuscripts was Wednesday. Furthermore, the top three frequently used databases were Embase, MEDLINE, and Cochrane. The most frequent number of authors in meta-analysis studies was four. Most studies focused on the periprosthetic hip and knee. The alpha-defensin diagnostic test, preventive measures on antibiotics use, and risk factors of intra-articular steroid injections were the most popular topic in recent years. Conclusion: Based on the results of the present study, we found that there was no single database covered all relevant articles, the optimal method for bibliometric analysis is a combination of databases. The most popular research topics on PJI focused on alpha-defensin, antibiotic use, risk factors of intra-articular steroid injections, and the location of prosthetic hip and knee infection. Alpha-defensin appears to be a reliable tool for the diagnosis of PJI.

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