Risk factors for periprosthetic joint infection in total knee arthroplasty

To evaluate the incidence and risk factors of periprosthetic joint infection (PJI) in patients undergoing total knee arthroplasty (TKA) in a high-volume hospital.

Records of 1133 primary TKAs were reviewed. Correlation between surgery volume and infection rate was determined. Risk factors for PJI were identified using case-control analysis of variables. TKAs performed between October 2012 and March 2013 without infection were used as controls.

Of 1133 TKAs, 8 (0.71%) PJI occurred. The organisms involved were Staphylococcus aureus (n=4), coagulase-negative staphylococci (n=2), Pseudomonas aeruginosa (n=1), and methicillin-resistant S aureus (n=1). In the 6-month period chosen as the control period, one (0.52%) out of 192 TKAs developed PJI. Hospital annual volume did not correlate with infection rate (p=0.766). Significant risk factors included young age, comorbidities such as diabetes, anaemia, thyroid disease, heart disease, lung disease, and long operating time. Six of the 8 patients with PJIs had at least one risk factor. However, the number of patients with infection was too small to have sufficient power.

Comorbidities are a risk factor for PJI. Perioperative optimisation of comorbidities and the use of antibiotic-loaded cement in patients with severe comorbidities should be considered.