Table I. Risk Factors Associated with Prosthetic Joint Infection Following Total Joint Arthroplasty*
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Risk Factors
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Barbari et al.3
Postoperative surgical site infection
NNS risk index >1
Systemic malignancy
Prior joint arthroplasty
Pulido et al.11
Morbid obesity (body-mass index >40 kg/m2
ASA score >2
Simultaneous bilateral surgery
Allogenic blood transfusion
Total knee arthroplasty
Longer hospital stays (mean, 5 days)
Postop. atrial fibrillation
Postop. myocardial infarction
Postop. urinary tract infection
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*NNIS - National Nocosomial Infections, Surveillance, and ASA = American Society of Anesthesiologists.
Table II. Risk Factors Associated with Prosthetic Joint Infection Following Total Hip Arthroplasty*
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Risk Factors
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Urquhart et al.12
Longer duration of surgery†
Illness severity (ASA score >3)†
Low-income patients (defined by the receipt of a Medicaid supplement)‡
Older patients (>75 yr)‡
Comorbidities (increased Charlson index)‡
NNIS risk index >1‡
Hospital with lower volume of procedures‡
Surgeon with lower volume of procedures‡
Posttraumatic osteoarthritis‡
Preoperative stay >2 days‡
Ong et al.13
Comorbidities (increased Charlson index)
Male gender
Longer duration of procedure (>210 min as compared with <120 min)
Patients receiving public assistance for Medicare premium
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* ASA = American Society of Anesthesiologists and NNIS - National Nocosomial Infections, Surveillance.
† Strong evidence in support of the risk factor presented by the studies included in the systematic review.
‡ Limited evidence presented by some but not all of the studies included in the systematic review.
Table III. Risk Factors Associated with Prosthetic Joint Infection Following Total Knee Arthroplasty
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Risk Factors
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Jämsen et al.14
Revision total knee arthroplasty
Male sex
Diagnosis of arthritic diseases (posttraumatic osteoarthritis, seropositive rheumatoid arthritis
Type of prostheses (constrained and hinged)
Comorbidities (increased Charlson index)
Lack of use of antibiotic impregnated cement
Postoperative complications (wound infection, hematoma, and wound necrosis)
Kurtz et al.15
Comorbidities (increased Charlson index >1)
Male sex
Patients receiving public assistance for Medicare premiums
Longer duration of surgery (>210 min as compared with <120 min)
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Table IV. Preoperative, Intraoperative, and Postoperative Strategies Used to Decrease the Rate of Periprosthetic Joint Infection Following Total Joint Arthroplasty*
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Preoperative
Early
Host optimization
Improve control of glucose and ulcers in diabetes
Control nidus of infection (dental clearance, etc.)
Malnutrition: Improve nutritional status
Obesity: decrease weight and improve nutritional status
Skin (psoriasis, eczema, ulcers)
Vascular insufficiency
Smoking cessation
MRSA‡ decolonization
Day of surgery
Surgical site shaving
Skin decontamination
Betadine shower
Chlorhexidine wipes/showers
Prophylactic antibiotics
Intraoperative
Surgical factors
Prophylactic antibiotics
Skin preparation
Draping
Charging scalpel blades
Antibiotic irrigation solution
Bleeding control
Antibiotic cement
Skin closure
Dressing
Surgical team
Gloves
Personalized protection suit
Surgical environment
Operating room traffic
Airflow
Postoperative
Immediate
Prophylactic antibiotics
Dealing with persistent draining wounds
Late
Antibiotics before dental, genitourinary, and gastrointestinal procedures
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* The preoperative period is further divided into an early period (prior to the day of surgery) and the day of surgery, whereas the postoperative period is divided into the immediate period (up to four weeks postoperatively) and a late period.
‡ MRSA = Methicillin-resistant Staphylococcus aureus.
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