Patients’ risk factors for periprosthetic joint infection in primary total hip arthroplasty: a meta-analysis of 40 studies

Abstract

Background Periprosthetic joint infection (PJI) is a catastrophic complication after total hip arthroplasty (THA). Our meta-analysis aimed to identify the individual-related risk factors that predispose patients to PJI following primary THA. Methods Comprehensive literature retrieval from Pubmed, Web of Science, and the Cochrane Library was performed from inception to Feb 20th, 2021. Patient-related risk factors were compared as per the modifiable factors (BMI, smoke and alcohol abuse), non-modifiable factors (gender, age), and medical history characteristics, such as diabetes mellitus (DM), avascular necrosis (AVN) of femoral head, femoral neck fracture, rheumatoid arthritis (RA), cardiovascular disease (CVD), and osteoarthritis (OA) etc. The meta-analysis was applied by using risk ratios with 95% corresponding intervals. Sensitivity analysis and publication bias were performed to further assess the credibility of the results. Results Overall, 40 studies with 3,561,446 hips were enrolled in our study. By implementing cumulative meta-analysis, higher BMI was found associated with markedly increased PJI risk after primary THA [2.40 (2.01–2.85)]. Meanwhile, medical characteristics including DM [1.64 (1.25–2.21)], AVN [1.65 (1.07–2.56)], femoral neck fracture [1.75 (1.39–2.20)], RA [1.37 (1.23–1.54)], CVD [1.34 (1.03–1.74)], chronic pulmonary disease (CPD) [1.22 (1.08–1.37)], neurological disease [1.19 (1.05–1.35)], opioid use [1.53 (1.35–1.73)] and iron-deficiency anemia (IDA) [1.15 (1.13–1.17)] were also significantly correlated with higher rate of PJI. Conversely, dysplasia or dislocation [0.65 (0.45–0.93)], and OA [0.70 (0.62–0.79)] were protective factors. Of Note, female gender was protective for PJI only after longer follow-up. Besides, age, smoking, alcohol abuse, previous joint surgery, renal disease, hypertension, cancer, steroid use and liver disease were not closely related with PJI risk. Conclusion Our finding suggested that the individual-related risk factors for PJI after primary THA included high BMI, DM, AVN, femoral neck fracture, RA, CVD, CPD, neurological disease, opioid use and IDA, while protective factors were female gender, dysplasia/ dislocation and OA.

Prosthetic Joint Infections of the Hip and Knee Among the Elderly: A Retrospective Study

“…Prior studies, mostly meta-analyses, have identified obesity, smoking, rheumatologic disease, and diabetes as potential risks factors for infection [5,22,28,31]. In our study, smoking, body mass index ≥30, and rheumatologic disease were significantly more common among patients <75 years of age.…”

The Role of Dexmedetomidine in the Structure of Anesthesia for Hip and Knee Arthroplastyс Surgery in Patients with Diabetes

“…Так, ЦД є одним із факторів ризику розвитку перипротезної інфекції у пацієнтів при первинному тотальному ЕККС [12,13]. Встановлено, що передопераційна гіпоальбумінемія (альбумін <35 г/л), ожиріння (ІМТ ≥40 кг/м 2 ), тютюнопаління і ЦД підвищують ризик післяопераційної інфекції, повторної госпіталізації, будь-яких ускладнень та смертності після тотального ендопротезування кульшового суглоба [14].…”

“…У 2 пацієнтів груп реґіонарної анестезії (у 2-й і 3-й по одному хворому -6,66%) на фоні початку анестезії і початку операції спостерігалася короткочасна гіпотензія зі зниженням САТ на 20-25 мм рт.ст. (15,(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) Як свідчить аналіз табл. 2, після проведення анестезії у групах побічні ефекти розвивалися не часто і були порівнянні між групами, за винятком частоти виникнення нудоти й блювання і, відповідно, застосування антиеметичних засобів.…”

Association between duration of anticoagulant thromboprophylaxis and revision rate in primary total hip arthroplasty: a Danish and Norwegian nationwide cohort study

“…However, it is questionable whether these factors are true confounders, because they also relate to selected exposure. Lastly, we did not consider the body mass index (BMI) of patients, despite BMI being a significant risk factor for PJI (32). It is possible that BMI is a confounder if the dose and duration of thromboprophylaxis is modified in patients with high BMI.…”