Risk Factors for Periprosthetic Joint Infection after Primary Total Knee Arthroplasty

Abstract

Periprosthetic joint infection (PJI) is a major adverse event of primary total knee arthroplasty (TKA) from the patient’s perspective, and it is also costly for health care systems. In 2010, the reported incidence of PJI in the first 2 years after TKA was 1.55%, with an incidence of 0.46% between the second and tenth year. In 2022, it has been published that 1.41% of individuals require revision TKA for PJI. The following risk factors have been related to an increased risk of PJI: male sex, younger age, type II diabetes, obesity class II, hypertension, hypoalbuminemia, preoperative nutritional status as indicated by prognostic nutritional index (PNI) and body mass index, rheumatoid arthritis, post-traumatic osteoarthritis, intra-articular injections prior to TKA, previous multi-ligament knee surgery, previous steroid therapy, current tobacco use, procedure type (bilateral), length of stay over 35 days, patellar resurfacing, prolonged operative time, use of blood transfusions, higher glucose variability in the postoperative phase, and discharge to convalescent care. Other reported independent risk factors for PJI (in diminishing order of importance) are congestive heart failure, chronic pulmonary illness, preoperative anemia, depression, renal illness, pulmonary circulation disorders, psychoses, metastatic tumor, peripheral vascular illness, and valvular illness. Preoperative intravenous tranexamic acid has been reported to diminish the risk of delayed PJI. Knowing the risk factors for PJI after TKA, especially those that are avoidable or controllable, is critical to minimizing (ideally preventing) this complication. These risk factors are outlined in this article.

Relationship between the severity of preoperative anemia and postoperative deep vein thrombosis in patients with bone trauma: a cohort study

“…The severity of anemia before surgery was associated with a prolonged hospital stay for patients. In addition, the perioperative infection rate [14,19], the occurrence of multiple postoperative complications, and preoperative waiting time contribute to the aggravation of anemia [20,21]. Infection, preoperative waiting time, and total hospital stay also increase the incidence of postoperative DVT [22].…”

Efficacy of DAIR in managing Candida parapsilosis-infected total knee arthroplasty with five-year follow-up: A case report and review of literature

“…Most patients with PJI present 1 or more specific risk factors, such as immunosuppression, obesity, diabetes, multiple previous revision surgeries, long-term antibiotic treatments, or even surgical season. [22][23][24][25][26][27] Recent findings indicate that nutritional status, particularly albumin levels, plays a crucial role in PJI management. Hypoalbuminemia may contribute to increased failure rates in treatment outcomes.…”

Local adiposity may be a more reliable predictor for infection than body mass index following total knee arthroplasty: a systematic review

“…Infection is a well‐documented complication following total knee arthroplasty (TKA) with considerable morbidity to the patient and burden to the health care system [2, 15, 16, 21]. Although the aggregate incidence of prosthetic joint infection (PJI) following TKA remains stable, there is expectation for increasing volume of post‐TKA infection given the projections for increasing rates of primary TKA [1, 4, 14, 18, 20].…”