Related Experiment Video
Updated: Mar 24, 2026
Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
Published on: February 2, 2024
Patient-Related Risk Factors for Periprosthetic Joint Infection after Total Joint Arthroplasty: A Systematic Review
Setor K Kunutsor1, Michael R Whitehouse1, Ashley W Blom1
1Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom.
Background:
Periprosthetic joint infections (PJIs) are dreaded complications of total joint arthroplasties. The risk of developing PJIs is likely to be influenced by several patient factors such as sociodemographic characteristics, body mass index (BMI), and medical and surgical histories. However, the nature and magnitude of the long-term longitudinal associations between these patient-related factors and risk of developing PJIs are uncertain.
Objective:
To conduct a systematic review and meta-analysis to assess the associations between several patient-related factors and PJI.
Data Sources:
MEDLINE, EMBASE, Web of Science, Cochrane Library, and reference lists of relevant studies from inception to September 2015.
Study Selection:
Longitudinal studies with at least one-year of follow-up for PJIs after total joint arthroplasty.
Data Extraction And Synthesis:
Two investigators extracted data on study characteristics, methods, and outcomes. A consensus was reached with involvement of a third. The relative risk (RR) with 95% confidence intervals was used as the summary measure of association across studies. Study-specific RRs with 95% confidence intervals were meta-analysed using random effect models and were grouped by study-level characteristics.
Results:
Sixty-six observational (23 prospective cohort and 43 retrospective cohort or case-control) studies with data on 512,508 participants were included. Comparing males to females and smokers to non-smokers, the pooled RRs for PJI were 1.36 (1.18-1.57) and 1.83 (1.24-2.70) respectively. There was no evidence of any significant associations of PJI with age and high alcohol intake. Comparing BMI ≥ 30 versus < 30 kg/m(2); ≥ 35 versus < 35 kg/m(2); and ≥ 40 versus < 40 kg/m(2); the pooled RRs were 1.60 (1.29-1.99); 1.53 (1.22-1.92); and 3.68 (2.25-6.01) respectively. Histories of diabetes, rheumatoid arthritis, depression, steroid use, and previous joint surgery were also associated with increased risk of PJI. The results remained similar when grouped by relevant study level characteristics.
Conclusions:
Several potentially modifiable patient-related factors are associated with the risk of developing PJIs. Identifying patients with these risk factors who are due to have arthroplasty surgery and modulating these risk factors might be essential in reducing the incidence of PJI. Further research is however warranted to assess the potential clinical utility of these risk factors as risk assessment tools for PJI.
Systematic Review Registration:
PROSPERO 2015: CRD42015023485.
Insights
Patient factors like smoking, high BMI, diabetes, and prior surgery increase periprosthetic joint infection (PJI) risk after joint replacement. Modifying these factors may help reduce PJI incidence.
Area of Science:
- Orthopedics
- Epidemiology
- Infectious Diseases
Background:
- Periprosthetic joint infections (PJIs) are significant complications following total joint arthroplasties.
- Patient-related factors, including sociodemographics, BMI, and medical/surgical history, may influence PJI risk.
- The long-term associations between these factors and PJI risk require clarification.
Purpose of the Study:
- To systematically review and meta-analyze patient-related factors associated with PJI risk.
- To quantify the magnitude of these associations.
Main Methods:
- Systematic review and meta-analysis of longitudinal studies with at least one-year follow-up.
- Searched MEDLINE, EMBASE, Web of Science, and Cochrane Library up to September 2015.
- Extracted data and calculated pooled relative risks (RRs) using random-effects models.
Main Results:
- Included 66 observational studies with 512,508 participants.
- Smokers (RR=1.83) and individuals with BMI ≥ 40 kg/m² (RR=3.68) had significantly higher PJI risk.
- Increased PJI risk was also linked to male sex, diabetes, rheumatoid arthritis, depression, steroid use, and prior joint surgery.
Conclusions:
- Several patient factors, some modifiable, are significantly associated with PJI risk.
- Identifying and managing these risk factors pre-arthroplasty may be crucial for PJI prevention.
- Further research is needed to evaluate these factors as clinical risk assessment tools for PJI.
