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

Chan, Vincent Wk; Chan, Ping Keung; Fu, Henry; Cheung, Michael K.; Cheung, Ankie Tan; Yan, Chun Hoi; Chiu, Kwong Yuen

doi:10.1177/2309499020947207

Cited by 21 publications

(17 citation statements)

References 82 publications

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“…The prevalence of poor nutritional status estimated by low levels of albumin and lymphocytes was very infrequent compared with previous studies (9,10), pointing towards a good nutritional status of the patients in general, except that 16% were defined as being vitamin-D deficient, ranging from 13-80% in the USA with prevalence of 42% (10).…”

Section: Discussionmentioning

confidence: 54%

“…Both are independent risk factors for PJI (3). Additionally, vitamin-D deficiency is more common among patients whose surgery is complicated by PJI (10). Smoking is a significant risk factor for postoperative wound complications with a rate of SSI of 1.8% for current smoking at the time of TJA compared with 1.3% and 1.1% in former smokers or nonsmokers, respectively.…”

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confidence: 99%

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Prevalence of modifiable risk factors in primary elective arthroplasty and their association with infections

Sigurdardottir

Sigurðsson

Ólafsson

et al. 2023

ActaO

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Background and purpose: The aim of this study was to identify the prevalence of modifiable risk factors of surgical site infections (SSI) in patients undergoing primary elective total joint arthroplasty (TJA) receiving conventional preoperative preparation, and to explore their association with infectious outcomes.Patients and methods: Information regarding modifiable risk factors (anemia, diabetes, obesity, nutritional status, smoking, physical activity) was prospectively gathered in patients undergoing primary TJA of hip or knee in 2018–2020 at a single institution with 6 weeks’ follow-up time.Results: 738 patients (median age 68 years [IQR 61–73], women 57%) underwent TJA (knee 64%, hip 36%). Anemia was detected in 8%, diabetes was present in 9%, an additional 2% had undiagnosed diabetes (HbA1c > 47 mmol/mol), and 8% dysglycemia (HbA1c 42–47 mmol/mol). Obesity (BMI ≥ 30) was observed in 52%. Serum albumin, total lymphocyte count, and vitamin D below normal limits was identified in 0.1%, 18%, and 16%, respectively. Current smokers were 7%. Surgical site complications occurred in 116 (16%), superficial SSI in 57 (8%), progressing to periprosthetic joint infection in 7 cases. Univariate analysis identified higher odds of superficial SSI for BMI ≥ 30 (OR 2.1, 95%CI 1.2–3.8) and HbA1c ≥ 42 mmol/mol (OR 2.2, CI 1.1–4.2), but no association was found with other factors.Conclusion: In a general population undergoing primary TJA an association was found between obesity (52%) and dysglycemia/diabetes (19%) and superficial SSI (8%), which progressed to PJI in 12% of cases, generating a 1% total rate of PJI. Modification of these risk factors might mitigate infectious adverse outcomes.

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Section: Discussionmentioning

confidence: 54%

mentioning

confidence: 99%

Prevalence of modifiable risk factors in primary elective arthroplasty and their association with infections

Sigurdardottir

Sigurðsson

Ólafsson

et al. 2023

ActaO

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“…Wsród przedoperacyjnych czynników, zwiększających ryzyko infekcji wymienia się Reumatoidalne Zapalenie Stawów, -a w szczególności zagrożeni infekcją są seropozytywni pacjenci płci męskiej, owrzodzenia skóry, wcześniejsze zabiegi przeprowadzone w obrębie kolana, zastosowanie protezy zawiasowej, otyłość, współistniejące zakażenie dróg moczowych, stosowanie steroidów, niewydolność nerek, cukrzyca, zły stan odżywienia, nowotwór złośliwy i łuszczyca [4,8,10,15]. Najczęstszymi patogenami powodującymi zakażenia okołoprotezowe stawów są gronkowce koagulazo-ujemne, i Staphylococcus aureus, stanowiące 50-60 % wszystkich PJI.…”

Section: Przedoperacyjne Czynniki Ryzyka I Patogenyunclassified

The diagnosis of periprosthetic joint infection after the arthroplasty of knee joint

TSITKO

DUDZIŃSKA

MILANOWSKA

et al. 2022

J Educ Health Sport

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Total knee replacement is one of the most widely performed surgeries. It is stated as the most efficient method of treating end-stage osteoarthritis of the knee joint. Due to the aging of the population and the prevalence of osteoarthritis, the number of arthroplasties is increasing every day. Such extensive surgical procedures are associated with a large number of postoperative complications, one of which is periprosthetic joint infection. The reported prevalence of PJI out to 2 years after knee replacement is 1.55 %. Misconceptions in the management of periprosthetic joint infection (PJI) can compromise the treatment success. The aim of the following article was to provide an overview of the medical knowledge on the periprosthetic joint infection after the arthroplasty of knee joint. Infections are caused by microbes that can enter the joint, which are most often coagulase-negative Staphylococci, Staphylococcus Aureus, Streptococci, Enterococci and Gram-negative bacteria. Fungal infections are much less common. The diagnostic process requires the involvement of a large group of medical personnel, which is why protocols with algorithms have been created to facilitate and standardize the diagnosis in the direction of periprosthetic joint infections. Mainly used tests from the patient's serum, synovial tests and histology. The positive results of the above tests are taken into account in the assessment of the fulfillment of the major and minor criteria to assess the likelihood of the occurrence of periprosthetic infection. This research paper aims to analyze the latest medical reports on the PJI diagnostic algorithm, laboratory and imaging studies of their effectiveness. This article was written based on analyzing data available in publications in Pubmed and Google Scholar databases

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“…This approach should not only acknowledge the specific challenges associated with PJI prevention but also factors in the evolving dynamics of antibiotic resistance [ 12 ]. Adequate learning of the main risk and protective factors for PJI can be a good starting point [ 13 ]. This article purposes to collect and summarize all the main risk factors for PJI available in the literature.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Risk Factors for Periprosthetic Joint Infection: A Narrative Review of the Literature

Lucenti,

Testa,

Caldaci

et al. 2024

Healthcare

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Periprosthetic joint infection (PJI) poses a challenging complication for many patients undergoing arthroplasty, and the literature identifies numerous risk factors. A comprehensive understanding of the primary risk and protective factors for PJI is valuable for surgeons. This article aims to compile and summarize the key risk factors for PJI documented in the literature. Some risk factors are related to the nutritional status of patients, with obesity, weight loss, hypovitaminosis, and malnutrition being frequently reported. Pathologies affecting patients also contribute to PJI risk, including septic arthritis, hepatitis, diabetes, urinary tract infections, anemia, hypothyroidism, osteoporosis, and dental pathologies. Unhealthy habits, such as tobacco and drug abuse, are significant factors. Previous corticosteroid injections may also play a role in infection development. A few protective factors are also reported in the literature (use of statins, preoperative decolonization, and preadmission skin preparation). The identification of risk factors and the implementation of evidence-based preoperative protocols are essential steps in reducing the incidence of PJI.

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

Cited by 21 publications

References 82 publications

Prevalence of modifiable risk factors in primary elective arthroplasty and their association with infections

Prevalence of modifiable risk factors in primary elective arthroplasty and their association with infections

The diagnosis of periprosthetic joint infection after the arthroplasty of knee joint

Preoperative Risk Factors for Periprosthetic Joint Infection: A Narrative Review of the Literature

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