Prevention of periprosthetic joint infection: Pre-, intra-, and post-operative strategies

Shahi, Alisina; Parvızı, Javad

doi:10.17159/2309-8309/2015/v14n3a6

Cited by 11 publications

(9 citation statements)

References 62 publications

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“…Our findings were in line with the previous studies; however, we found that some modifiable risk factors such as iron deficiency anemia and obesity can contribute significantly to the incidence of postoperative VTEs. Our study emphasizes on the importance of perioperative health modifications before an elective THA and TKA [20] , [21] , [22] .…”

Section: Discussionmentioning

confidence: 98%

What are the incidence and risk factors of in-hospital mortality after venous thromboembolism events in total hip and knee arthroplasty patients?

et al. 2018

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BackgroundPulmonary embolism and deep vein thrombosis, together referred to as venous thromboembolism (VTE), are serious and potentially preventable complications after total hip arthroplasty and total knee arthroplasty. The aim of this study was to investigate the incidence of mortality after VTE events and assess the risk factors that are associated with it.MethodsThe Nationwide Inpatient Sample was used to estimate the total number of total hip arthroplasty, total knee arthroplasty, VTE events, and mortality using the International Classification of Diseases, Ninth Revision procedure codes from 2003 to 2012. Patients' demographics, Elixhauser, and Charlson comorbidity indices were used to identify the risk factors associated with in-hospital VTEs and mortality.ResultsA total of 1,805,621 THAs and TKAs were included. The overall rate of VTE was 0.93%. The in-hospital mortality rate among patients with VTEs was 7.1% vs 0.30% in patients without VTEs (P-value < .0001). The risk factors for mortality after VTE events in descending order were as follows: hypercoagulable state (odds ratio [OR]: 5.3, 95% confidence interval [CI]: 3.6-5.8), metastatic cancer (OR: 5.2, 95% CI: 3.3-5.6), myocardial infarction (OR: 4.2, 95% CI: 2.3-4.7), peripheral vascular disease (OR: 3.6, 95% CI: 3.2-4.0), cardiac arrhythmias (OR: 3.2, 95% CI: 1.6-4.3), advanced age (OR: 3.1, 95% CI: 2.3-3.7), electrolyte disorders (OR: 3.1, 95% CI: 2.2-3.6), pulmonary circulation disorders (OR: 2.9, 95% CI: 2.6-3.3), depression (OR: 2.8, 95% CI: 1.6-3.4), complicated diabetes (OR: 2.7, 95% CI: 2.1-3.2), weight loss (OR: 2.6, 95% CI: 2.2-3.3), renal failure (OR: 2.6, 95% CI: 1.7-3.5), chronic pulmonary disease (OR: 2.5, 95% CI: 1.3-3.1), valvular disease (OR: 2.4, 95% CI: 1.8-2.7), liver disease (OR: 1.7, 95% CI: 1.2-1.9), and obesity (OR: 1.6, 95% CI: 1.5-1.9).ConclusionsIn-hospital VTE has a significant in-hospital mortality rate. Several of the identified risk factors in this study are modifiable preoperatively. We strongly urge the orthopaedic community to be cognizant of these risk factors and emphasize on optimizing patients' comorbidities before an elective arthroplasty.

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Section: Discussionmentioning

confidence: 98%

What are the incidence and risk factors of in-hospital mortality after venous thromboembolism events in total hip and knee arthroplasty patients?

et al. 2018

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“…Although numerous risk factors have been identified for PJI, only a subset of these may be modifiable 22 . In addition, as the number of comorbidities in patients undergoing TJA increases, high-risk patients will become more prevalent 23,24 . It is therefore essential for healthcare professionals to carefully assess each patient's risk profile and develop individualized strategies for preventing PJI.…”

Section: Oral Pji Prophylaxismentioning

confidence: 99%

The Use of Oral Antibiotics After Total Joint Arthroplasty

Tidd,

Pasqualini,

McConaghy

et al. 2023

JBJS Reviews

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» There is conflicting and insufficient evidence that extended oral antibiotic (EOA) therapy prevents infection in high-risk patients undergoing primary total joint arthroplasty (TJA), limiting recommendation for or against the practice.» In the case of aseptic revision TJA, the evidence is also conflicting and limited by underlying confounders, preventing recommendation for use of EOA.» There is fair evidence that use of EOA after debridement antibiotic therapy and implant retention of the prosthesis prolongs infection-free survival, but randomized controlled trials are needed. On the other hand, there is strong evidence that patients undergoing 2-stage revision should receive a period of suppressive oral antibiotics after the second stage.» The optimal duration of EOA in primary TJA, aseptic revision, and debridement antibiotic therapy and implant retention of the prosthesis is unknown. However, there is strong evidence that 3 months of EOA suppression may be appropriate after reimplantation as part of 2-stage exchange arthroplasty.» Complications secondary to EOA are reported to be between 0% and 13.7%, yet are inconsistently reported and poorly defined. The risks associated with antibiotic use, including development of antimicrobial resistance, must be weighed against a possible decrease in infection rate.

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“…Pseudomonas aeruginosa and Acinetobacter baumannii are aerobic Gram-negative bacteria that are becoming a frequent cause of hospital infections, as in the case of nosocomial pneumonia associated with a high mortality rate [25]. These organisms are mainly responsible for septicemias, infections related to the use of central venous catheters, intestinal and urinary tract infections, pneumonia, endocarditis, and meningitis, but they can also cause osteomyelitis, septic arthritis, periprosthetic infections, and infections of the skin and soft tissues (for example surgical wound infections).…”

Section: Microbiological Etiopathogenesis Of Pjismentioning

confidence: 99%

Prosthetic joint infections and legal disputes: a threat to the future of prosthetic orthopedics

Basile

Gallina

Passeri³

et al. 2021

J Orthop Traumatol

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Prosthetic joint infections (PJI) represent one of the major problems in orthopedic prosthetic surgery. The incidence of PJIs varies according to the site of intervention, and different published case studies report occurrence at 0.5 to 3.0% in the event of first implants, with a significant greater risk in the case of prosthesis revisions. The diagnosis of prosthetic infections is seldom simple, needing a multi-specialist approach, which includes the accurate collection of patient anamnesis, its clinical evaluation, the evaluation of inflammation biomarkers, and the use of imaging techniques. It is essential to identify the bacteria responsible for the infection not only for an accurate diagnosis, but also to select the correct antibiotic treatment. Failure to identify the bacteria involved makes it impossible to establish targeted systemic antibiotic therapy. In developed countries such as Italy, the right to health is guaranteed by the Constitution, where the institutions that provide health services must be staffed by a team of medical professionals that can guarantee the safest possible health pathways. Risk management represents the set of actions aimed at improving the quality of the care provided, the adherence to guidelines and good care practices with the final objective of guaranteeing patients’ safety. All hospitals, including the ones where prosthetic orthopedic surgery is performed, must adopt clinical risk management procedures which, through prospective tools aimed at preventing errors and complications and by retrospective methods, permit the identification of critical points in the different phases of the process and propose actions for improvement. The constant increase in litigation for malpractice in Western countries, especially in Italy, calls for special attention to the problem of PJIs and the in-depth assessment of medico-legal problems, also considering the new legislative initiatives in the field of medical malpractice. Hospitals need to tackle the onset of PJIs in a transparent and linear fashion by constantly informing the patient on their progress.

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Prevention of periprosthetic joint infection: Pre-, intra-, and post-operative strategies

Cited by 11 publications

References 62 publications

What are the incidence and risk factors of in-hospital mortality after venous thromboembolism events in total hip and knee arthroplasty patients?

What are the incidence and risk factors of in-hospital mortality after venous thromboembolism events in total hip and knee arthroplasty patients?

The Use of Oral Antibiotics After Total Joint Arthroplasty

Prosthetic joint infections and legal disputes: a threat to the future of prosthetic orthopedics

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