A Bundle Protocol to Reduce the Incidence of Periprosthetic Joint Infections After Total Joint Arthroplasty: A Single-Center Experience

Bullock, Matthew; Brown, Matthew L.; Bracey, Daniel N.; Langfitt, Maxwell K.; Shields, John S.; Lang, Jason E.

doi:10.1016/j.arth.2016.11.028

Cited by 38 publications

(38 citation statements)

References 78 publications

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“…In our study, only hypoalbuminemia was found to be significant in the regression analysis. Other studies examining similar interventions, such as those of Nussenbaum et al [7] and Bullock et al [8], have reported comparable infection rates among primary TKAs. Both studies noted significant decreases in the infection rates after implementation of preoperative screening and optimization criteria.…”

Section: Discussionmentioning

confidence: 80%

“…A total of 683 cases were identified by querying the billing records using Current Procedural Terminology codes 27447 and 27487. Fourteen cases were excluded for the following reasons: malignancy (8), trauma (ie, periprosthetic fractures) (2), lack of follow-up (1), conversion of a patellofemoral joint replacement to a TKA (1), and surgery outside of study inclusion dates (2). All revision TKA surgeries included were aseptic revisions.…”

Section: Methodsmentioning

confidence: 99%

“…Identification and optimization of modifiable risk factors is an important goal as up to half of all PJIs may be preventable through the application of evidence-based strategies [6]. Careful patient selection and preoperative optimization of modifiable risk factors have become targets to minimize the risk of adverse outcomes such as PJIs [7,8]. Unfortunately, bestpractice screening guidelines and preoperative optimization are not part of the routine practice of all orthopaedic surgeons.…”

Section: Introductionmentioning

confidence: 99%

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Does Adherence to Preoperative Surgical Selection Criteria Reduce the Rate of Prosthetic Joint Infection in Primary and Revision Total Knee Arthroplasties?

et al. 2020

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Background: There has been recent increased focus on the importance of modifiable risk factors that can affect the risk of potentially avoidable complications such as prosthetic joint infection (PJI). We aimed to assess the relationship between adherence to a preoperative optimization protocol at our institution and its influence on the rate of PJI after primary and revision total knee arthroplasty (TKA). Methods: A single-institution, retrospective study was conducted on all elective primary and revision TKAs performed over a 2-year period. PJI was diagnosed using the 2011 Musculoskeletal Infection Society criteria. Surgical outcomes and PJI were assessed relative to adherence to preoperative optimization criteria. Compliance was set as a binary variable with any case that did not meet all criteria deemed noncompliant. Results: A total of 669 TKAs met inclusion criteria, including 510 primary and 159 revision TKAs. Overall compliance was 61.3%. There were 26 PJIs (3.9%) in total. The PJI rate was 1.2% (6) among primary and 14.4% (20) among revision TKAs. The rate of PJI among cases that met the preoperative optimization criteria was 2.4% (5), and the rate among cases that did not was 6.2% (21) (P < .05). Conclusions: Adherence to preoperative optimization criteria may decrease the incidence of PJI after primary and revision TKA, but further study is needed to confirm the findings of this study.

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Section: Discussionmentioning

confidence: 80%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Does Adherence to Preoperative Surgical Selection Criteria Reduce the Rate of Prosthetic Joint Infection in Primary and Revision Total Knee Arthroplasties?

et al. 2020

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“…Surgery was also postponed for patients at high PJI risk (HbA1c > 7.5, BMI > 40, laboratory evidence of malnutrition) to allow for modification of these risk factors or a proven effort to do so. Using a bundled intervention with similar elements, Bullock et al [45] compared 90-day infection rates before and after implementation. Comparing the 2 years before and after implementation, there was a reduction in the THR infection rate from 1.56 (10 of 641) to 0.59% (4 of 675); however, this reduction was not statistically significant (p = 0.09).…”

Section: Outcomes Of Bundled Infection Prevention Interventionsmentioning

confidence: 99%

Contemporary Strategies to Prevent Infection in Hip and Knee Arthroplasty

Batty

Lanting

2020

Curr Rev Musculoskelet Med

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Purpose of Review Prosthetic joint infection (PJI) remains a serious concern in lower limb arthroplasty. Despite the significant consequences of PJI, the assessment of the safety and efficacy of preventative measures is challenging due to a low event rate. Notwithstanding, enormous efforts have been made in this arena, and prevention strategies continue to evolve. This review provides an update on contemporary literature (published within the last 5 years) pertaining to infection prevention in primary hip and knee arthroplasty. Recent Findings Patient optimization has been highlighted as a critical preoperative factor in mitigating PJI risk. Recent evidence emphasizes the importance of preoperative glycaemic control, nutritional status, weight optimization and smoking cessation prior to hip and knee arthroplasty. Perioperatively, attention to detail in terms of surgical skin preparation agent and technique as well as prophylactic antibiotic agent, spectrum, dose and timing is important with statistically and clinically significant differences seen between differing strategies. Intraosseous regional antibiotic administration is an emerging technique with promising preclinical data. Dilute betadine lavage also shows promise. Data supporting bundled interventions continues to grow. Summary A multimodal approach is required in PJI prevention, and attention to detail is important with each element. Patient optimization is critical, as is the execution of the planned perioperative infection prevention strategy.

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“…Contemporary value-based healthcare models have appropriately incentivized the avoidance of PJI [2]. During the past decade, sophisticated preoperative risk-factor recognition has become the standard of care in elective TJA.…”

mentioning

confidence: 99%

CORR Insights®: What Are the Frequency, Associated Factors, and Mortality of Amputation and Arthrodesis After a Failed Infected TKA?

Drew

2017

Clinical Orthopaedics &Amp; Related Research

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The author certifies that neither he, nor any members of his immediate family, have any commercial associations (such as consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR 1 or The Association of Bone and Joint Surgeons 1. This CORR Insights 1 comment refers to the article available at

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A Bundle Protocol to Reduce the Incidence of Periprosthetic Joint Infections After Total Joint Arthroplasty: A Single-Center Experience

Cited by 38 publications

References 78 publications

Does Adherence to Preoperative Surgical Selection Criteria Reduce the Rate of Prosthetic Joint Infection in Primary and Revision Total Knee Arthroplasties?

Does Adherence to Preoperative Surgical Selection Criteria Reduce the Rate of Prosthetic Joint Infection in Primary and Revision Total Knee Arthroplasties?

Contemporary Strategies to Prevent Infection in Hip and Knee Arthroplasty

CORR Insights®: What Are the Frequency, Associated Factors, and Mortality of Amputation and Arthrodesis After a Failed Infected TKA?

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