To identify risk factors for periprosthetic joint infection following primary total joint arthroplasty, a systematic search was performed in Pubmed, Embase and Cochrane library databases. Pooled odds ratios (ORs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Patient characteristics, surgical-related factors and comorbidities, as potential risk factors, were investigated. The main factors associated with infection after total joint arthroplasty (TJA) were male gender (OR, 1·48; 95% CI, 1.19-1.85), age (SMD, -0·10; 95% CI, -0.17--0.03), obesity (OR, 1·54; 95% CI, 1·25-1·90), alcohol abuse (OR, 1·88; 95% CI, 1·32-2·68), American Society of Anesthesiologists (ASA) scale > 2 (OR, 2·06; 95% CI, 1·77-2·39), operative time (SMD, 0·49; 95% CI, 0·19-0·78), drain usage (OR, 0·36; 95% CI, 0·18-0·74), diabetes mellitus (OR, 1·58; 95% CI, 1·37-1·81), urinary tract infection (OR, 1·53; 95% CI, 1.09-2.16) and rheumatoid arthritis (OR, 1·57; 95% CI, 1·30-1·88). Among these risk factors, ASA score > 2 was a high risk factor, and drain usage was a protective factor. There was positive evidence for some factors that could be used to prevent the onset of infection after TJA.

https://www.onlinelibrary.wiley.com/doi/epdf/10.1111/iwj.12640

Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta‐analysis

Background:Recent studies have shown that intra-articular injections ≤3 months before total knee arthroplasty increase the risk of periprosthetic joint infection. We are aware of no previous study that has differentiated the risk of periprosthetic joint infection on the basis of the type of medicati

Comparison of Infection Risk with Corticosteroid or Hyaluronic Acid Injection Prior to Total Knee Arthroplasty.

It is well established that certain patient-specific risk factors affect outcomes following total joint arthroplasty. The goal of this paper is to summarize the latest data on several variables that have been investigated in the last 3 years and to characterize the effects these factors have on the success of hip and knee replacement. Preoperative diagnoses of depression and anxiety, liver disease, hypoalbuminemia, vitamin D deficiency, and diabetes mellitus are associated with increased risk of postoperative complications and can lead to worse outcomes after joint replacement surgery. Recent investigations have clearly established a link between these patient-specific factors and poor outcomes after hip and knee arthroplasty, but future research is needed to determine best practices for stratifying and mitigating these risks for patients.

/pdf/factors-that-affect-outcome-following-total-joint-1stomzx3j3.pdf

Factors That Affect Outcome Following Total Joint Arthroplasty: a Review of the Recent Literature.

The Diagnosis and Prevention of Periprosthetic Joint Infections Clinical Practice Guideline is based on a systematic review of current scientific and clinical research. Through analysis of the current best evidence, this guideline seeks to evaluate strategies to mitigate the risk of periprosthetic joint infection (PJI) in hip and knee arthroplasty and identify best practices in the diagnostic evaluation for these infections. Twenty-five recommendations related to prevention and diagnosis of PJI are presented. In addition, the work group highlighted areas for needed additional research when evidence proved lacking on the topic and carefully reviewed the rationale behind the recommendations while also noting potential harms or risks associated with implementation.

Diagnosis and Prevention of Periprosthetic Joint Infections.

The effect of preoperative lumbar epidural corticosteroid injection on postoperative infection rate in patients undergoing single-level lumbar decompression.

The aim of the study is to identify the risks associated with an intraarticular injection before a total knee arthroplasty (TKA). A total of 1628 patients were retrospectively studied over a 7-year period. The patients were divided into 2 groups: patient who received an intraarticular injection before a TKA and patients who did not receive an injection before a TKA. There were 16 deep infections identified (0.98%). Ten deep infections were identified in the patients who did not receive an injection before a TKA (1.18%), and 6 deep infections were identified in patients who received an injection before a TKA (0.77%). There does not appear to be a correlation with the timing of the injection before surgery and increased risk of infection.

The Risk of a Deep Infection Associated With Intraarticular Injections Before a Total Knee Arthroplasty

We present a case of peroneal nerve palsy which occurred 12 years after primary total knee arthroplasty as a result of extensive tibial osteolysis. The tibial osteolytic cyst extended through a cortical defect in the proximal tibia into the anterolateral compartment of the leg causing compressive neuropathy of the peroneal nerve. Imaging included radiographs, CT scan and MRI. At revision surgery, the tibial component was found loose with significant proximal tibial osteolysis. The cyst in the leg was decompressed through the cortical defect in the proximal tibia and analysis of cystic fluid revealed polyethylene debris. At 7-year follow-up after revision, the osteolytic cyst had resolved but the peroneal palsy did not recover.

Bozena Kuczynski

Papers

The Risk of a Deep Infection Associated With Intraarticular Injections Before a Total Knee Arthroplasty

Delayed peroneal nerve palsy after total knee arthroplasty—A rare complication of tibial osteolysis