Predicting lower limb periprosthetic joint infections: A review of risk factors and their classification

Table 3 Host-related risk factors

	Ref.	Statistical parameter					Site
		HR	OR	RR	95%CI	P value
General
Age: 65-75 yr (compared to 45-65)	[26]		3.36		1.30-8.69	0.013	Hip/knee
Comorbidities (total number)	[10]		1.35		1.10-1.66	0.005	Hip/knee
Charlson index + 5 (compared to 0)	[14]		2.57		1.96-3.37	< 0.001	Hip
Place of residence (rural)	[26]		2.63		1.13-6.10	0.025	Hip/knee
Hispanic race (compared to White)	[20]	0.69			0.49-0.98	0.038	Knee
Alcohol abuse	[26]		2.95		1.06-8.23	0.039	Hip/knee
Tobacco use	[29]		1.47		1.21-1.78	0.001	Hip/knee
	[31]		3.4		1.23-9.44	0.029	Hip/knee
	[32]	3.91	3.4		1.19-12.84	0.032	Hip/knee
Tobacco use (S aureus colonization)	[23]		12.76		2.47-66.16	0.017	Hip
Gender
Female	[14]		0.83			0.009	Hip
Male	[18]			1.9	1.80-2.10	< 0.001	Hip
	[20]	1.89			1.54-2.32	< 0.001	Knee
	[31]		3.55		1.60-7.84	0.002
Endocrine disorders
Diabetes mellitus	[4]		1.19		1.06-1.34	0.0025	Knee
	[26]		5.47		1.77-16.97	0.003	Hip/knee
	[22]	1.46			1.27-1.68	0.0007	Hip
	[9]		4		1.13-14.18	0.032	Hip/knee
	[20]	1.28			1.03-1.60	0.025	Knee
	[17]	2.31			1.12-4.72	< 0.001	Hip/knee
	[15]		1.4		0.90-2.10	0.06	Hip/knee
	[5]		1.8		1.20-2.80	0.006	Hip/knee
	[13]		3.1			0.02	Hip/knee
	[44]		2.21		1.34-3.64	0.001	Knee
Pre-op BM > 6.9 mmol/L	[17]	2.25			0.60-8.50	0.073	Hip/knee
Pre-operative hyperglycemia	[30]	1.44			1.09-1.89	0.008	Hip/knee
Psychiatric disorders
Depression	[4]		1.28		1.08-1.51	0.0035	Knee
	[16]	1.6			1.32-1.93	0.0039	Hip
Psychosis	[16]	1.74			1.38-2.20	0.0044	Hip
	[4]		1.26		1.02-1.57	0.0331	Knee
Haematological disorders
Preoperative anaemia	[16]	1.36			1.15-1.62	0.0005	Hip
	[19]		1.95		1.41-2.69	< 0.001	Hip/knee
	[4]		1.26		1.09-1.45	0.0014	Knee
Coagulopathy	[16]	1.58			1.24-2.01	0.0002	Hip
Malignancy
Metastatic malignancy	[4]		1.59		1.03-2.47	0.0369	Knee
Tumour 5 yr before implant	[5]		3.1		1.30-7.20	< 0.01	Hip/knee
Cardiovascular disorders
Congestive heart failure	[4]		1.28		1.13-1.46	< 0.0001	Knee
	[16]	1.57			1.33-1.84	0.0409	Hip
Cardiac arrhythmia	[16]	1.48			1.30-1.70	0.0012	Hip
Coronary artery disease	[21]		5.10		1.30-19.8	0.017	Hip/knee
Valvular disease	[4]		1.15		1.01-1.31	0.039	Knee
Peripheral vascular disease	[4]		1.13		1.01-1.27	0.0381	Knee
	[16]	1.44			1.24-1.68	0.0032	Hip
Gastroenterology disorders
Liver cirrhosis	[28]	5.4				< 0.001	Hip
	[28]	3.4				< 0.001	Knee
Hepatitis B virus (amongst males)	[44]		4.32		1.85-10.09	< 0.001	Knee
OGD with biopsy	[22]		2.8		1.10-7.10	0.03	Hip/knee
Respiratory disorders
Chronic pulmonary disease	[4]		1.22		1.10-1.36	< 0.0001	Knee
	[31]		4.34		1.28-14.70	0.041	Both
Pulmonary circulation disorders	[4]		1.42		1.06-1.91	0.0205	Knee
Renal disorders
Renal disease	[4]		1.38		1.11-1.71	0.0038	Knee
Renal function (mL/min)	[15]		1		0.90-1.00	0.05	Hip
Rheumatoid arthritis
Rheumatoid arthritis	[15]		3.3		0.80-13.90	0.09	Hip/knee
	[4]		1.18		1.02-1.37	0.0277	Knee
	[16]	1.71			1.42-2.06	< 0.0001	Hip
ASA grade
ASA score	[15]		2.2		1.30-4.00	0.006	Hip/knee
Mean score	[11]		2.07		1.08-1.97	0.03	Hip/knee
3 (compared to 1 or 2)	[20]	1.65			1.33-2.00	< 0.001	Knee
> 4	[12]	1.95			1.00-3.70	0.04	Hip/knee
Body mass index
Obesity	[4]		1.22		1.03-1.44	0.0219	Knee
	[16]	1.73			1.35-2.22	< 0.0001	Hip
BMI (kg/m2)	[15]		1.1		1.00-1.10	0.05	Hip
	[12]	3.23			1.60-6.50	0.001	Hip/knee
< 20	[21]		6		1.20-30.9	0.033	Hip/knee
25-30	[5]		0.4		0.30-0.70	< 0.001	Hip/knee
≥ 28 (compared to 18.5-28)	[26]		2.77		1.20-6.40	0.017	Hip/knee
31-39	[5]		0.5		0.30-0.70	< 0.001	Hip/knee
35 (compared to < 35)	[20]	1.47			1.17-1.85	0.001	Knee
	[32]	1.84			1.11-3.05	0.007	Both
> 40	[23]		4.13		1.30-12.88	0.01	Hip
	[13]		3.3			0.045	Knee
	[17]	6.41			1.67-24.59	< 0.001	Hip/knee
> 50	[13]		18.3			< 0.001	Hip/knee
Malnutrition	[25]		2.3		1.50-3.50	< 0.001	Hip/knee
Serum albumin < 3.5 g/dL	[33]		2		1.50-2.80	< 0.001	Hip/knee
Immunocompromise
Immunocompromise	[5]		2.2		1.60-3.00	< 0.001	Hip/knee
Inflammatory disease	[18]			1.4	1.10-1.70	0.001	Hip
Prednisone dose exceeds 15 mg/d	[21]		21		3.50-127.2	< 0.001	Hip/knee
Systemic steroid therapy	[15]		3.3		0.80-13.90	0.09	Hip/knee
Infection
Distant organ infection	[5]		2.2		1.50-3.25	< 0.001	Hip/knee
Nasal S. Aureus Infection	[31]		3.95		1.80-8.71	< 0.001	Hip/knee
Nasal MRSA Infection	[31]		8.24		3.23-21.02	< 0.001	Hip/knee
Asymptomatic bacteriuria	[27]		3.23		1.67-6.27	0.001	Hip/knee
Genitourinary infection	[10]		2.8		1.01-7.77	0.048	Hip/knee
Operative indication
Hip fracture	[18]			2.1	1.90-2.40	< 0.001	Hip
Post-traumatic osteoarthritis	[20]	3.23			1.68-6.23	< 0.001	Knee
Prior operation on the index joint	[5]		1.9		1.30-2.60	< 0.001	Hip/knee
Per additional surgery	[32]		2.88		1.45-5.80	0.018	Hip/knee
Avascular necrosis	[18]			1.7	1.40-2.10	< 0.001	Hip

RR: Relative risk; HR: Hazard ratio; OR: Odds ratio.