Predicting lower limb periprosthetic joint infections: A review of risk factors and their classification

Abstract

AIMTo undertook a systematic review to determine factors that increase a patient’s risk of developing lower limb periprosthetic joint infections (PJI).METHODSThis systematic review included full-text studies that reviewed risk factors of developing either a hip or knee PJI following a primary arthroplasty published from January 1998 to November 2016. A variety of keywords were used to identify studies through international databases referencing hip arthroplasty, knee arthroplasty, infection, and risk factors. Studies were only included if they included greater than 20 patients in their study cohort, and there was clear documentation of the statistical parameter used; specifically P-value, hazard ratio, relative risk, or/and odds ratio (OR). Furthermore a quality assessment criteria for the individual studies was undertaken to evaluate the presence of record and reporting bias.RESULTSTwenty-seven original studies reviewing risk factors relating to primary total hip and knee arthroplasty infections were included. Four studies (14.8%) reviewed PJI of the hip, 3 (11.21%) of the knee, and 20 (74.1%) reviewed both joints. Nineteen studies (70.4%) were retrospective and 8 (29.6%) prospective. Record bias was identified in the majority of studies (66.7%). The definition of PJI varied amongst the studies but there was a general consensus to define infection by previously validated methods. The most significant risks were the use of preoperative high dose steroids (OR = 21.0, 95%CI: 3.5-127.2, P < 0.001), a BMI above 50 (OR = 18.3, P < 0.001), tobacco use (OR = 12.76, 95%CI: 2.47-66.16, P = 0.017), body mass index below 20 (OR = 6.00, 95%CI: 1.2-30.9, P = 0.033), diabetes (OR = 5.47, 95%CI: 1.77-16.97, P = 0.003), and coronary artery disease (OR = 5.10, 95%CI: 1.3-19.8, P = 0.017).CONCLUSIONWe have highlighted the need for the provider to optimise modifiable risk factors, and develop strategies to limit the impact of non-modifiable factors.

The World Association against Infection in Orthopaedics and Trauma (WAIOT) procedures for Microbiological Sampling and Processing for Periprosthetic Joint Infections (PJIs) and other Implant-Related Infections

“…Periprosthetic joint infection (PJI) remains a serious complication in orthopaedic surgery. The infection rate after primary knee or hip replacement is estimated to range between 0.3 and 1.9% [1], and may exceed 10% in revision surgery or in patients with specific risk factors [2]. Similarly, the incidence of infection after internal osteosynthesis (intramedullary nails, plates, screws, etc.)…”

Chronic kidney disease is associated with a risk of higher mortality following total knee arthroplasty in diabetic patients: a nationwide population-based study

“…Periprosthetic joint infection (PJI) is a serious problem following total knee arthroplasty (TKA) [ 1 , 2 ]. The associated risk factors include surgical, environmental and host factors [ 3 ]. Orthopaedic surgeons have made great efforts to improve surgical outcomes, however medical comorbidities such as diabetes mellitus (DM) and chronic kidney disease (CKD) are still common risk factors leading to PJI [ 2 , 4 , 5 ].…”

Risk Factors for Prosthetic Joint Infection after Primary Hip Arthroplasty

“…При анализе послеоперационного периода мы не нашли статистически значимой зависимости между развитием инфекции и применяемыми схемами антибактериальной и антикоагуляционной профилактики, несмотря на указание важности данных критериев в профилактике развития ППИ в литературе [22,29,30,31]. Возможной причиной этого является то, что при лечении всех пациентов не допускалось отступления от схем антибактериальной и антикоагуляционной профилактики, принятых в нашем учреждении.…”