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Risk Factors for Periprosthetic Joint Infection after Primary Total Knee Arthroplasty
Emerito Carlos Rodriguez-Merchan1,2, Alberto D Delgado-Martinez3,4
1Department of Orthopedic Surgery, La Paz University Hospital, Paseo de la Castellana 261, 28046 Madrid, Spain.
Insights
Periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) affects 1.41% of patients. Identifying and managing modifiable risk factors is crucial for preventing PJI and improving patient outcomes.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Arthroplasty Research
Background:
- Periprosthetic joint infection (PJI) is a significant complication following total knee arthroplasty (TKA).
- PJI incidence rates have remained substantial, with 1.41% of patients requiring revision TKA for infection in 2022.
- The economic burden and patient impact of PJI necessitate a thorough understanding of its risk factors.
Purpose of the Study:
- To comprehensively review and outline the known risk factors associated with PJI after TKA.
- To highlight modifiable and controllable risk factors to guide preventative strategies.
- To inform clinicians and patients about the multifactorial nature of PJI risk.
Main Methods:
- Systematic review and synthesis of published literature on PJI risk factors after TKA.
- Categorization of risk factors based on patient demographics, comorbidities, surgical factors, and postoperative management.
- Analysis of reported incidence rates and trends in PJI following TKA.
Main Results:
- Numerous risk factors identified, including male sex, diabetes, obesity, hypertension, nutritional status, and specific surgical choices like patellar resurfacing.
- Comorbidities such as congestive heart failure, chronic pulmonary illness, and anemia are significant independent risk factors.
- Preoperative intravenous tranexamic acid may reduce the risk of delayed PJI.
Conclusions:
- Understanding the diverse risk factors for PJI after TKA is essential for effective prevention strategies.
- Focusing on modifiable factors like nutritional status, diabetes management, and surgical technique can help minimize PJI incidence.
- Continued research and clinical vigilance are necessary to further reduce the burden of PJI in total knee arthroplasty.
Abstract:
Periprosthetic joint infection (PJI) is a major adverse event of primary total knee arthroplasty (TKA) from the patient's perspective, and it is also costly for health care systems. In 2010, the reported incidence of PJI in the first 2 years after TKA was 1.55%, with an incidence of 0.46% between the second and tenth year. In 2022, it has been published that 1.41% of individuals require revision TKA for PJI. The following risk factors have been related to an increased risk of PJI: male sex, younger age, type II diabetes, obesity class II, hypertension, hypoalbuminemia, preoperative nutritional status as indicated by prognostic nutritional index (PNI) and body mass index, rheumatoid arthritis, post-traumatic osteoarthritis, intra-articular injections prior to TKA, previous multi-ligament knee surgery, previous steroid therapy, current tobacco use, procedure type (bilateral), length of stay over 35 days, patellar resurfacing, prolonged operative time, use of blood transfusions, higher glucose variability in the postoperative phase, and discharge to convalescent care. Other reported independent risk factors for PJI (in diminishing order of importance) are congestive heart failure, chronic pulmonary illness, preoperative anemia, depression, renal illness, pulmonary circulation disorders, psychoses, metastatic tumor, peripheral vascular illness, and valvular illness. Preoperative intravenous tranexamic acid has been reported to diminish the risk of delayed PJI. Knowing the risk factors for PJI after TKA, especially those that are avoidable or controllable, is critical to minimizing (ideally preventing) this complication. These risk factors are outlined in this article.
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