Infection prevention in total knee arthroplasty: current concepts, controversies, and a clinical algorithm

Area of Science:

• Orthopedic Surgery
• Infectious Disease Prevention
• Biomedical Engineering

Background:

• Periprosthetic Joint Infection (PJI) is a severe complication of Total Knee Arthroplasty (TKA).
• Current prevention strategies have not significantly reduced PJI incidence.
• A comprehensive approach is needed to mitigate PJI risks.

Purpose of the Study:

• To review current strategies for preventing PJI in TKA.
• To focus on risk stratification, perioperative optimization, and clinical decision-making algorithms.
• To provide a clinically oriented overview for PJI prevention.

Main Methods:

• A narrative literature review was conducted using major medical databases.
• Priority was given to recent systematic reviews, meta-analyses, and high-quality clinical studies.
• Studies focused on patient-related, intraoperative, and postoperative factors.

Main Results:

• PJI is multifactorial, influenced by patient, surgical, and postoperative elements.
• Modifiable risk factors (obesity, diabetes, smoking) require preoperative optimization.
• Strict aseptic techniques, antibiotic prophylaxis, and wound management are essential.

Conclusions:

• Effective PJI prevention demands a structured, multimodal approach across all care phases.
• Risk stratification allows for personalized strategies and improved planning.
• A proposed clinical algorithm can standardize PJI prevention pathways.