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Author Spotlight: Advancing Research on Candida albicans Biofilm-Associated Prosthetic Joint Infections
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Risk factors for periprosthetic joint infection following primary total knee arthroplasty: a systematic review and

Jiashun Li1, Zhen Liu1, Zheng Wang2

  • 1Sixth Affiliated Hospital of Xinjiang Medical University, Orthopedic Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.

Frontiers in Surgery
|January 26, 2026
PubMed

Insights

Periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is a serious complication. Key risk factors include longer operative time, obesity, male gender, diabetes, longer hospital stay, immunosuppressant use, hypoalbuminemia, and systemic inflammatory disease.

Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Biostatistics

Background:

  • Periprosthetic joint infection (PJI) is a severe complication of total knee arthroplasty (TKA), leading to significant morbidity and implant failure.
  • Existing evidence on risk factors for PJI following TKA is inconsistent, necessitating a comprehensive review.

Purpose of the Study:

  • To systematically review and meta-analyze the risk factors associated with PJI after primary TKA.
  • To provide Level II evidence for identified risk factors to guide clinical practice and future research.

Main Methods:

  • A systematic literature search was conducted across multiple databases (PubMed, Cochrane Library, Embase, CNKI, Wanfang, VIP, SinoMed) up to August 2025.
  • Meta-analyses were performed using Review Manager 5.4, infection risk was analyzed using STATA 18, and incidence rates were analyzed using R 4.5.1.
  • Twenty primary studies were included in the meta-analysis.

Main Results:

  • Eight risk factors were significantly associated with an increased risk of PJI after primary TKA.
  • These include longer operative time (OR=9.10), obesity (OR=13.95), male gender (OR=2.67), diabetes (OR=2.98), longer hospital stay (OR=1.73), immunosuppressant use (OR=5.76), hypoalbuminemia (OR=6.24), and systemic inflammatory disease (OR=3.47).

Conclusions:

  • Longer operative time, obesity, male gender, diabetes, longer hospital stay, immunosuppressant use, hypoalbuminemia, and systemic inflammatory disease are confirmed risk factors for PJI post-TKA.
  • This meta-analysis provides robust Level II evidence supporting these identified risk factors.
Abstract

Keywords:
PJITKAmeta-analysisperiprosthetic joint infectionrisk factorstotal knee arthroplasty

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