General Assembly, Prevention, Host Risk Mitigation - General Factors: Proceedings of International Consensus on Orthopedic Infections

Jiranek, William A.; Kigera, James; Klatt, Brian A.; Küçükdurmaz, Fatih; Lieberman, Jay R.; Moser, Claus; Mulhall, Kevin; Nahouli, Hasan; Schwarz, Edward M.; Shohat, Noam; Tarabichi, Majd

doi:10.1016/j.arth.2018.09.052

Cited by 16 publications

(7 citation statements)

References 89 publications

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“…However, a strong correlation between diabetes and deep postoperative infections was confirmed by this and other studies [34]. Diabetes was also recognised as an important risk factor for infection by the International Consensus Meeting on Periprosthetic Joint Infections [35]; a comparable trend was found in our data (OR = 2.92), but this result was not statistically significant (p = 0.06 IC: 0.94-9.11).…”

Section: Discussionsupporting

confidence: 83%

Is It the Surgeon, the Patient, or the Device? A Comprehensive Clinical and Radiological Evaluation of Factors Influencing Patient Satisfaction in 648 Total Knee Arthroplasties

Rissolio

Sabatini

Risitano

et al. 2021

JCM

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Total knee arthroplasty (TKA) is a successful and safe surgical procedure for treating osteoarthritic knees, but despite the overall good results, some patients remain dissatisfied. The aim of this study is to evaluate the influence of patient-related and surgery-related variables in a consecutive group of patients that underwent TKA. Individuals (n = 648) who had TKA performed between 01 January 2013 and 31 December 2017 were enrolled in the study. Postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS) and Forgotten Joint score (FJS-12) were collected at a mean follow-up of 4.79 years. Patient satisfaction was assessed with a questionnaire. Determinants of satisfaction (age, sex, smoking, presence of diabetes or cardiovascular disease, pain in other joints, preoperative arthritic stage) and components of satisfaction (slope variation, mechanical axis variation, outlier final alignment, surgeon experience) were examined to identify which variables correlated with positive outcome. Correlations with septic and mechanicals failures were also evaluated. Thirteen percent of patients were unsatisfied, despite good results in KOOS, WOMAC and FJS-12 tests. Female gender, low Kellgren–Lawrence grade and the presence of back pain and pain in other joints were factors associated with poor clinical results. Poorer clinical results were also reported in younger patients. Infection rate was correlated with active smoking and mechanical failure with an outlier final alignment. Comorbidities, smoking habits and high expectations have a big influence on TKA results and on final satisfaction after surgery.

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Section: Discussionsupporting

confidence: 83%

Is It the Surgeon, the Patient, or the Device? A Comprehensive Clinical and Radiological Evaluation of Factors Influencing Patient Satisfaction in 648 Total Knee Arthroplasties

Rissolio

Sabatini

Risitano

et al. 2021

JCM

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“…Historically, patients with uncontrolled diabetes have been found to have a 2.8 times increased risk of infection after TJA [ 12 , 13 ]. More recently, the critical role of acute glycemic control in patients undergoing TJA has been determined since multiple studies have shown patients with peri-operative hyperglycemia, not simply diabetes alone, have a significantly higher risk for complications [ 14 , 15 ]. Blood glucose levels between 110 and 180 mg/dL, a non-fasting glucose value less than 200 mg/dL, and a hemoglobin A1c value less than 7.5–8% have all been reported as ideal for elective TKA [ 13 , 14 , 15 ].…”

Section: Preoperative Factors Increasing Pji Riskmentioning

confidence: 99%

Prevention of Periprosthetic Joint Infection (PJI): A Clinical Practice Protocol in High-Risk Patients

et al. 2020

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Background: Periprosthetic joint infection (PJI) represents 25% of failed total knee arthroplasties (TKA). The European Knee Associates (EKA) formed a transatlantic panel of experts to perform a literature review examining patient-related risk factors with the objective of producing perioperative recommendations in PJI high-risk patients. Methods: Multiple databases (Pubmed/MEDLINE, EMBASE, Scopus, Cochrane Library) and recommendations on TKA PJI prevention measures from the International Consensus Meetings on PJI from the AAOS and AAHKS were reviewed. This represents a Level IV study. Results: Strong evidence was found on poor glycemic control, obesity, malnutrition, and smoking being all associated with increased rates of PJI. In the preoperative period, patient optimization is key: BMI < 35, diet optimization, Hemoglobin A1c < 7.5, Fructosamine < 292 mmol/L, smoking cessation, and MRSA nasal screening all showed strong evidence on reducing PJI risk. Intraoperatively, a weight-based antibiotic prophylaxis, accurate fluid resuscitation, betadine and chlorhexidine dual skin preparation, diluted povidone iodine solution irrigation, tranexamic acid administration, and monofilament barbed triclosan-coated sutures for soft tissues closure all represented effective prevention measures. In the postoperative period, failure to reach normalization of ESR, CRP, D-dimer, and IL-6 six weeks postoperatively suggested early PJI. Conclusion: The current recommendations from this group of experts, based on published evidence, support risk stratification to identify high-risk patients requiring implementation of perioperative measures to reduce postoperative PJI.

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“…Traditionally, patients with uncontrolled diabetes have been found to have a 2.8 times increased risk of infection after arthroplasty [14, 42]. Acute glycemic control in patients undergoing arthroplasty plays a critical role as well; multiple reports have shown that patients with peri‐operative hyperglycemia, even those without diabetes, have a significantly higher risk of complications [35, 37]. This single response question investigates the practice of detecting hyperglycemia preoperatively.…”

Section: Resultsmentioning

confidence: 99%

“Recommendations for periprosthetic joint infections (PJI) prevention: the European Knee Associates (EKA)–International Committee American Association of Hip and Knee Surgeons (AAHKS)–Arthroplasty Society in Asia (ASIA) survey of members”

Indelli

Iannotti

Ferretti

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose Periprosthetic joint infections (PJIs) represent a devastating consequence of total joint arthroplasty. The European Knee Associates (EKA), the American Association of Hip and Knee Surgeons (AAHKS) International Committee, and the Arthroplasty Society in Asia (ASIA) board members were interested in quantifying diferences in arthroplasty surgeons' use of various PJI prevention measures to provide clinical recommendations to reduce PJI incidence. Methods A prospective Microsoft Forms online survey was distributed among EKA, AAHKS International Committee, and ASIA members and their ailiated arthroplasty surgeons. The survey consisted of 20 single and multiple response questions focused on PJI prevention strategies at three perioperative periods: preoperatively, intraoperatively, and postoperatively. Results Three hundred and ninety-four arthroplasty surgeons from 6 diferent continents completed the survey. Preoperative: (A) PJI Risk Stratiication: 40.6% routinely set thresholds (e.g., BMI, HgbA1C) to be met to qualify for surgery, 36.5% only review past medical history; 9.1% use machine learning to personalize PJI risk; (B) BMI limit: 36% no limit; 15.4% BMI < 35; 30.9% BMI < 40; 17.2% BMI < 45; (C) Nutritional status: 55.3% do not screen; among those who screen their patients (44.7%), albumin is the single most used marker (86.3%); (D) Hyperglycemia/Diabetes: 83.3% check this comorbidity; 88.1% use HgbA1C as single best screening test; (E) MRSA nasal colonization: 63.7% do not test; 28.9% test all patients; 7.4% test selectively. Intraoperative: (A) Antibiotic prophylaxis in high-risk patients: 43.4% use single antibiotic for 24 h; 21.3% use double antibiotic for 24 h; 14.2% use single/double antibiotic for 7 days postoperatively; (B) Skin-cleansing: 68.7% at home (45.6% chlorhexidine sponge; 11.9% clippers); (C) Intraoperative skin disinfection: 46.9% single chlorhexidine; 25% double chlorhexidine-povidone-iodine;15.4% single povidone-iodine; (D) Tranexamic acid (TXA) to reduce bleeding/SSI: 96% yes (51% double IV dose, 35.2% single IV dose, 23.6% intra-articular injection); (E) Surgical suction drain: 52% do not use drains; 19.7% use a drain < 24 h; (F) Intra-articular lavage: 64.9% use only saline; 28.1% use dilute povidone-iodine; (G) Antibiotic local delivery to prevent PJI: 82.4% use antibiotic-added cement. Postoperative: (A) Routine monitoring of PJI serologic markers: 42% only in symptomatic patients; 34.2% do not; 20.8% in all patients; (B) Serologic markers to rule in/out PJI: 95.9% CRP; 71% SEDRATE; 60.6% WBC; (C) Synovial luid test to rule in/out PJI: 79.6% culture/sensitivity; 69.5% WBC count; 31.4% CRP.Conclusions This survey demonstrated that notable diferences still exist in the application of PJI preventive measures across diferent geographic areas: Optimizing the patient preoperatively and applying multimodal intraoperative strategies represent newer, clinically relevant steps in the efort to reduce the burden of PJI. More uniform guidelines still need to be produced from international sc...

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General Assembly, Prevention, Host Risk Mitigation - General Factors: Proceedings of International Consensus on Orthopedic Infections

Cited by 16 publications

References 89 publications

Is It the Surgeon, the Patient, or the Device? A Comprehensive Clinical and Radiological Evaluation of Factors Influencing Patient Satisfaction in 648 Total Knee Arthroplasties

Is It the Surgeon, the Patient, or the Device? A Comprehensive Clinical and Radiological Evaluation of Factors Influencing Patient Satisfaction in 648 Total Knee Arthroplasties

Prevention of Periprosthetic Joint Infection (PJI): A Clinical Practice Protocol in High-Risk Patients

“Recommendations for periprosthetic joint infections (PJI) prevention: the European Knee Associates (EKA)–International Committee American Association of Hip and Knee Surgeons (AAHKS)–Arthroplasty Society in Asia (ASIA) survey of members”

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