Identification and preoperative optimization of risk factors to prevent periprosthetic joint infection

Abstract

Despite significant improvements over the past several decades in diagnosis, treatment and prevention of periprosthetic joint infection (PJI), it still remains a major challenge following total joint arthroplasty. Given the devastating nature and accelerated incidence of PJI, prevention is the most important strategy to deal with this challenging problem and should start from identifying risk factors. Understanding and well-organized optimization of these risk factors in individuals before elective arthroplasty are essential to the ultimate success in reducing the incidence of PJI. Even though some risk factors such as demographic characteristics are seldom changeable, they allow more accurate expectation regarding individual risks of PJI and thus, make proper counseling for shared preoperative decision-making possible. Others that increase the risk of PJI, but are potentially modifiable should be optimized prior to elective arthroplasty. Although remarkable advances have been achieved in past decades, many questions regarding standardized practice to prevent this catastrophic complication remain unanswered. The current study provide a comprehensive knowledge regarding risk factors based on general principles to control surgical site infection by the review of current literature and also share own practice at our institution to provide practical and better understandings.

Keywords: Total joint arthroplasty, Periprosthetic joint infection, Prevention, Risk factors, Preoperative optimization

Core tip: Despite general success in joint arthroplasty, periprosthetic joint infection remains a serious challenge. With the accelerated incidence and increased charges, PJIs are expected to impose substantial medical and socioeconomic burden in the future. There is no debate that the prevention is the first and the best strategy to minimize this catastrophic complication and the specific strategies for prevention should be integrated into and be in accordance with the general principles to control surgical site infection. Thus, we provide a comprehensive approach based on these general principles as well as own specific practice at our institution for better understandings.