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Risk Factors for Infection After Ankle, Knee, Hip, Shoulder, or Elbow Arthroscopy: A Systematic Review and
Anouska Saraf1, Sage Iwamoto1, Sakshi Krishna1
1School of Medicine, Vanderbilt University, Nashville, Tennessee, USA.
The American Journal of Sports Medicine
|April 2, 2026
Summary
Postarthroscopy infection risk is elevated by steroid injections within 4 weeks of surgery, diabetes, obesity (BMI >30), and smoking. Patient-specific interventions are crucial for mitigating these risks and improving outcomes after arthroscopic procedures.
Area of Science:
- Orthopaedic Surgery
- Infectious Disease Epidemiology
- Evidence-Based Medicine
Background:
- Arthroscopy is a common orthopedic procedure with known infection risks.
- Previous studies on risk factors are limited by joint specificity and patient numbers, leading to inconsistencies.
Purpose of the Study:
- To systematically review and analyze predictive risk factors for postarthroscopy infections.
- To cover multiple joints including the ankle, knee, hip, shoulder, and elbow.
Main Methods:
- Systematic review and meta-analysis of studies from PubMed, Scopus, and Embase.
- Pooled analysis of patient-specific factors including smoking, diabetes mellitus (DM), body mass index (BMI), and corticosteroid injection (CSI) timing.
Main Results:
- Postarthroscopic infection risk is significantly increased by intraoperative or preoperative CSI (within 4 weeks), DM, BMI >30, and smoking.
- Overall infection rate was 0.84%, with variations by joint: elbow (2.3%) highest, ankle (0.27%) lowest.
- Knee (0.61%), hip (0.59%), and shoulder (0.47%) had low infection rates.
Conclusions:
- Intraoperative or recent preoperative corticosteroid injections, elevated BMI, diabetes, and smoking are significant risk factors for postarthroscopy infections.
- Patient-specific risk factor assessment and targeted interventions are essential for improving outcomes.
- Addressing modifiable risk factors can help mitigate infection risk in patients undergoing arthroscopy.
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