Published online May 18, 2017. doi: 10.5312/wjo.v8.i5.400
Peer-review started: October 28, 2016
First decision: December 1, 2016
Revised: January 5, 2017
Accepted: March 12, 2017
Article in press: March 13, 2017
Published online: May 18, 2017
To undertook a systematic review to determine factors that increase a patient’s risk of developing lower limb periprosthetic joint infections (PJI).
This systematic review included full-text studies that reviewed risk factors of developing either a hip or knee PJI following a primary arthroplasty published from January 1998 to November 2016. A variety of keywords were used to identify studies through international databases referencing hip arthroplasty, knee arthroplasty, infection, and risk factors. Studies were only included if they included greater than 20 patients in their study cohort, and there was clear documentation of the statistical parameter used; specifically P-value, hazard ratio, relative risk, or/and odds ratio (OR). Furthermore a quality assessment criteria for the individual studies was undertaken to evaluate the presence of record and reporting bias.
Twenty-seven original studies reviewing risk factors relating to primary total hip and knee arthroplasty infections were included. Four studies (14.8%) reviewed PJI of the hip, 3 (11.21%) of the knee, and 20 (74.1%) reviewed both joints. Nineteen studies (70.4%) were retrospective and 8 (29.6%) prospective. Record bias was identified in the majority of studies (66.7%). The definition of PJI varied amongst the studies but there was a general consensus to define infection by previously validated methods. The most significant risks were the use of preoperative high dose steroids (OR = 21.0, 95%CI: 3.5-127.2, P < 0.001), a BMI above 50 (OR = 18.3, P < 0.001), tobacco use (OR = 12.76, 95%CI: 2.47-66.16, P = 0.017), body mass index below 20 (OR = 6.00, 95%CI: 1.2-30.9, P = 0.033), diabetes (OR = 5.47, 95%CI: 1.77-16.97, P = 0.003), and coronary artery disease (OR = 5.10, 95%CI: 1.3-19.8, P = 0.017).
We have highlighted the need for the provider to optimise modifiable risk factors, and develop strategies to limit the impact of non-modifiable factors.
Core tip: This systematic review determines the most statistically significant factors that increase a patient’s risk of developing lower limb periprosthetic joint infections. Reviewing all relevant papers until November 2016 through international databases, we have included 27 original studies. The results include multiple factors relating to the patient and the Institute, as well as post-operative predictors and causes of infection. This ultimately reiterates the importance of optimising the patients pre-operatively by addressing modifiable risk factors (such as their immunosuppression, nutrition, diabetes, and smoking), and develops strategies to limit the impact of non-modifiable factors.