Patients' risk factors for periprosthetic joint infection in total hip arthroplasty: A systematic review and meta-analysis of 34 studies

Abstract

BackgroundPeriprosthetic joint infection (PJI) is a catastrophic complication following total hip arthroplasty (THA). This meta-analysis aimed to identify the individual-related risk factors that predispose patients to PJI undergoing THA.MethodsWe performed extensive literature retrieval from related databases from inception to October 20, 2019. Patient-related risk factors were compared and grouped according to 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. Meta-analysis was performed using risk ratios with 95% corresponding intervals. Sensitivity analysis and publication bias were performed to assess the credibility of the results.ResultsOverall, 34 studies with 2,141,960 hips were included. By implementing cumulative meta-analysis, we found that higher BMI significantly increased the rate of PJI after THA. Meanwhile, medical characteristics comprising DM, AVN, femoral neck fracture, RA, CVD, chronic pulmonary disease and neurological disease, were also markedly associated with higher PJI risk. Conversely, dysplasia or dislocation, and OA were protective factors. Notably, female gender was protective for PJI only after longer follow-up. Besides, age, smoking, alcohol abuse, previous joint surgery, renal disease, hypertension, cancer and steroid use were not correlated with risk of PJI.ConclusionOur finding indicates that the main risk factors for PJI are high BMI, DM, AVN, femoral neck fracture, RA, CVD, chronic pulmonary disease, and neurological disease. Protective factors are female gender, dysplasia/ dislocation and OA.