Anesthetic Management and Infection Risk in Hip and Knee Arthroplasty: A Narrative Review

Surgical site infection (SSI) and periprosthetic joint infection (PJI) remain among the most serious complications after total hip and knee arthroplasty, potentially leading to delayed recovery, revision surgery, prolonged antimicrobial treatment, increased healthcare costs, and worse functional outcomes. This narrative review evaluates how perioperative anesthetic management may influence infection risk in patients undergoing hip and knee arthroplasty and summarizes practical measures that anesthesia providers can take to contribute to infection prevention. The review first compares general, neuraxial, and regional anesthetic techniques and their potential effects on immune function, neuroendocrine stress responses, tissue perfusion, oxygenation, and postoperative analgesic requirements. It then addresses aseptic practices relevant to the anesthesia work area during arthroplasty, including hand hygiene, glove use, safe medication preparation, management of airway and vascular equipment, skin antisepsis for anesthesia-related invasive procedures, and adherence to operating-room infection-control protocols. Drug-related considerations include timely antibiotic prophylaxis, the immunomodulatory and glycemic effects of dexamethasone, infection risks associated with improper propofol handling, and the potential influence of perioperative opioid exposure. Postoperative recovery strategies, including multimodal analgesia, early mobilization, and appropriate management of invasive devices, are also discussed. Finally, preoperative optimization strategies relevant to hip and knee arthroplasty are reviewed, including glycemic control, nutritional support, smoking cessation, anemia management, screening and decolonization for Staphylococcus aureus, and structured prehabilitation. Overall, prevention of SSI and PJI after hip and knee arthroplasty requires multidisciplinary, protocol-based perioperative care integrating anesthetic decision-making with established surgical, nursing, and infection-control measures.