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Risk factors for periprosthetic joint infection after total knee arthroplasty

Juan F Blanco1,2, Agustín Díaz3,4, Francisco R Melchor5

  • 1Department of Trauma and Orthopedic Surgery, University Hospital of Salamanca, Salamanca, Spain. jfblanco@usal.es.

Archives of Orthopaedic and Trauma Surgery
|November 11, 2019
PubMed

Insights

Prolonged operative and tourniquet times are key risk factors for total knee arthroplasty (TKA) periprosthetic joint infection (PJI). Identifying and managing modifiable factors like obesity and diabetes can help reduce TKA PJI rates.

Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Biostatistics

Background:

  • Periprosthetic joint infection (PJI) is a severe complication following total knee arthroplasty (TKA).
  • The incidence of TKA is rising, potentially increasing future PJI cases.
  • Identifying risk factors is crucial for preventing TKA PJI.

Purpose of the Study:

  • To identify significant risk factors associated with TKA PJI.
  • To provide evidence for reducing TKA PJI rates through risk factor management.

Main Methods:

  • A case-control study involving 66 TKA PJI patients and 66 control TKA patients.
  • Data collection included demographic and clinical variables.
  • Logistic regression and attributable risk fraction analysis were employed.

Main Results:

  • Prolonged operative time (>90 min) and tourniquet time (>60 min) were highly significant risk factors (OR 40.77 and OR 37.14, respectively).
  • Other significant risk factors included non-antibiotic-loaded cement (OR 3.62), obesity (BMI >30, OR 8.86), diabetes (OR 2.33), high ASA grade (III-IV, OR 15.30), and blood transfusion (OR 4.60).
  • These factors were independently associated with TKA PJI.

Conclusions:

  • Operative time, tourniquet time, cement type, diabetes, obesity, ASA grade, and blood transfusion are independently linked to TKA PJI.
  • Focusing on modifiable risk factors offers a strategy to decrease TKA PJI incidence.
  • This study underscores the importance of optimizing surgical parameters and managing patient comorbidities.
Abstract

Keywords:
Periprosthetic joint infectionRisk factorTotal knee arthroplasty

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