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Acta Scientific Orthopaedics (ISSN: 2581-8635)

Review Article Volume 8 Issue 8

Periprosthetic Infection: Better Safe Than Sorry. Evidence-Based Scoping Review

Mohamed Hashem1 and Hatem Hussein2*

1Frimley Health NHS Foundation Trust Frimley. England, UK
2Southend University Hospital- Mid and South Essex NHS trust. England, UK

*Corresponding Author: Hatem Hussein, Southend University Hospital- Mid and South Essex NHS trust. England, UK.

Received: April 09, 2025; Published: July 28, 2025

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Abstract

Background: Periprosthetic joint infection (PJI) is a devastating complication following total joint arthroplasty (TJA) with increased morbidity, prolonged hospital stays, and significant healthcare costs. Despite advancements in surgical techniques and perioperative protocols, infection rates remain between 1% and 2% for primary procedures, with higher rates in revision surgery [1]. As to be safe is better than to be sorry, we have conducted this evidenced-based review to address:

1. What are the key perioperative risk factors contributing to PJI?
2. Evidence-based best practices to mitigate these risks?

Methods: A comprehensive review of PJI identifying preoperative, intraoperative, and postoperative risk factors, preventive measures, and evidence-based strategies was conducted on PubMed, Scopus, and Web of Science databases with prioritization of high-quality meta-analyses, randomized controlled trials (RCTs), and systematic reviews, following Clinical Orthopaedics and Related Research (CORR) guidelines [2]. Step-by step approach to identify these risk factors and best practices mitigating each risk was proposed.

Discussion: PJI accounts for approximately 6,000 revision procedures annually in the UK, with a 4.5-fold increase in healthcare costs compared to uneventful primary TJA [3]. Preventive measures, including but not only patient optimization, strict antibiotic prophylaxis, enhanced surgical asepsis, early mobilization, and wound surveillance, significantly reduced infection rates [4]. Our evidence-based approach offers a unique practical insight to achieve this.

Conclusion: A multidisciplinary approach integrating preoperative risk stratification, patient intraoperative infection control, and structured postoperative surveillance can keep patient safe rather than sorry regarding periprosthetic infection. Since our approach strictly adhere to robust quality evidence-based guidelines with practical view, it can significantly reduce infection rates, improve outcomes, and decrease healthcare costs [5].

Keywords: Periprosthetic joint infection, Clinical Orthopaedics

References

  1. Tande AJ and Patel R. “Prosthetic joint infection”. Clinical Microbiology Reviews2 (2014): 302-345.
  2. Parvizi J and Gehrke T. “Definition of periprosthetic joint infection”. The Journal of Arthroplasty7 (2014): 1331.
  3. National Joint Registry. 16th Annual Report (2023).
  4. Zimmerli W., et al. “Prosthetic-joint infections”. The New England Journal of Medicine16 (2004): 1645-1654.
  5. Berbari EF., et al. “Outcome of prosthetic joint infection in patients with rheumatoid arthritis”. Clinical Infectious Diseases 2 (2006): 216-223.
  6. Kurtz SM., et al. “Economic burden of periprosthetic joint infection in the United States”. The Journal of Arthroplasty8 (2012): 61-65.e1.
  7. Bozic KJ., et al. “The epidemiology of revision total knee arthroplasty in the United States”. Clinical Orthopaedics and Related Research1 (2010): 45-51.
  8. Kapadia BH., et al. “Periprosthetic joint infection”. Lancet10016 (2016): 386-394.
  9. Jämsen E., et al. “Prevention of deep infection in joint replacement surgery”. Acta Orthopaedica 6 (2010): 660-666.
  10. American Academy of Orthopaedic Surgeons. Appropriate use criteria for the management of periprosthetic joint infection (2019).
  11. Fleisher LA., et al. “2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery”. Journal of the American College of Cardiology 22 (2014): e77-137.
  12. Charalambous CP., et al. “Septic arthritis following intra-articular steroid injection of the knee”. The Annals of The Royal College of Surgeons of England 5 (2006): 480-482.
  13. Marchant MH Jr., et al. “The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty”. Journal of Bone and Joint Surgery American Volume 7 (2009): 1621-1619.
  14. Namba RS., et al. “Obesity and perioperative morbidity in total hip and total knee arthroplasty patients”. The Journal of Arthroplasty7-3 (2014): 46-50.
  15. Naylor KL., et al. “The three-year incidence of fracture in chronic kidney disease”. Kidney International4 (2014): 810-818.
  16. Greenky M., et al. “Preoperative anemia in total joint arthroplasty: is it associated with periprosthetic joint infection?” Clinical Orthopaedics and Related Research10 (2012): 2695-2701.
  17. Goodman SM., et al. “American College of Rheumatology/American Association of Hip and Knee Surgeons guideline for the perioperative management of antirheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty”. Arthritis and Rheumatology 8 (2007): 1538-1551.
  18. Jensen JE., et al. “Nutrition in orthopaedic surgery”. Journal of Bone and Joint Surgery American Volume9 (1982): 1263-1272.
  19. Evans DC., et al. “Nutrition optimization prior to surgery”. Nutrition in Clinical Practice 1 (2014): 10-21.
  20. Møller AM., et al. “Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial”. Lancet9301 (2002): 114-117.
  21. Harris AH., et al. “Preoperative alcohol screening scores and postoperative complications in older veterans”. The American Journal of Surgery 6 (2011): 713-718.
  22. Bode LG., et al. “Preventing surgical-site infections in nasal carriers of Staphylococcus aureus”. The New England Journal of Medicine1 (2010): 9-17.
  23. Rao N., et al. “A preoperative decolonization protocol for staphylococcus aureus prevents orthopaedic infections”. Clinical Orthopaedics and Related Research6 (2008): 1343-1348.
  24. “American Society of Anesthesiologists. Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration”. Anesthesiology 3 (2017): 376-393.
  25. Ridgeway S., et al. “Infection of the surgical site after arthroplasty of the hip”. The Journal of Bone and Joint Surgery British Volume 6 (2005): 844-850.
  26. Brandt C., et al. “Operating room ventilation with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery”. Annals of Surgery 5 (2008): 695-700.
  27. Tanner J and Parkinson H. “Double gloving to reduce surgical cross-infection”. Cochrane Database of Systematic Reviews 3 (2006): CD003087.
  28. Pugely AJ., et al. “A comparison of neuraxial anesthesia versus general anesthesia for elective total joint arthroplasty”. The Journal of Arthroplasty8 (2013): 78-81.
  29. Memtsoudis SG., et al. “Perioperative comparative effectiveness of anesthetic technique in orthopedic patients”. Anesthesiology5 (2013): 1046-1058.
  30. Bratzler DW., et al. “Clinical practice guidelines for antimicrobial prophylaxis in surgery”. American Journal of Health-System Pharmacy 3 (2013): 195-283.
  31. Parvizi J., et al. “Efficacy of antibiotic-impregnated cement in total hip replacement”. Acta Orthopaedica 3 (2008): 335-341.
  32. Mangram AJ., et al. “Guideline for prevention of surgical site infection, 1999”. Infection Control and Hospital Epidemiology 4 (1999): 250-278.
  33. Zhang W., et al. “The effects of a tourniquet used in total knee arthroplasty: a meta-analysis”. Journal of Orthopaedic Surgery and Research 9 (2014): 13.
  34. Alshryda S., et al. “Tranexamic acid in total knee replacement: a systematic review and meta-analysis”. The Journal of Bone and Joint Surgery British Volume12 (2011): 1577-1585.
  35. Stannard JP., et al. “Incisional negative pressure wound therapy after high-risk lower extremity fractures”. Journal of Orthopaedic Trauma 1 (2012): 37-42.
  36. Norman G., et al. “Antibiotics and antiseptics for surgical wounds healing by secondary intention”. Cochrane Database Systematic Review 3 (2016): CD011712.
  37. Pearse EO., et al. “Early mobilisation after conventional knee replacement may reduce the risk of postoperative venous thromboembolism”. The Journal of Bone and Joint Surgery British Volume3 (2007): 316-322.
  38. Brandstrup B., et al. “Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens”. Annals of Surgery 5 (2003): 641-648.
  39. Prokuski L. “Prophylactic antibiotics in orthopaedic surgery”. Journal of the American Academy of Orthopaedic Surgeons 5 (2008): 283-293.
  40. Maheshwari AV., et al. “Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center”. Clinical Orthopaedics and Related Research6 (2009): 1418-1423.
  41. Husted H., et al. “Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients”. Acta Orthopaedica 2 (2008): 168-173.
  42. Parvizi J., et al. “Prevention of periprosthetic joint infection: new guidelines”. The Journal of Bone and Joint Surgery 99-B.4 (2017): 3-10.
  43. Gehrke T and Parvizi J. “Proceedings of the International Consensus Meeting on Periprosthetic Joint Infection” (2013).
  44. Jiranek WA., et al. “Surgical treatment of prosthetic joint infections of the hip and knee: changing paradigms?” The Journal of Arthroplasty 6 (2015):912-918.
  45. Romanò CL., et al. “Antibacterial coating of implants in orthopaedics and trauma: a classification proposal in an evolving panorama”. Journal of Orthopaedic Surgery and Research 10 (2015): 157.
  46. Romanò CL., et al. “Antibacterial coating of implants in orthopaedics and trauma: a classification proposal in an evolving panorama”. Journal of Orthopaedic Surgery and Research 10 (2015): 157.
  47. Tande AJ and Patel R. “Prosthetic joint infection”. Clinical Microbiology Reviews2 (2014): 302-345.
  48. Parvizi J and Gehrke T. “Definition of periprosthetic joint infection”. The Journal of Arthroplasty 7 (2014): 1331.
  49. National Joint Registry. 16th Annual Report (2023).
  50. Zimmerli W., et al. “Prosthetic-joint infections”. The New England Journal of Medicine16 (2004): 1645-1654.
  51. Berbari EF., et al. “Outcome of prosthetic joint infection in patients with rheumatoid arthritis”. Clinical Infectious Diseases2 (2006): 216-223.
  52. Kurtz SM., et al. “Economic burden of periprosthetic joint infection in the United States”. The Journal of Arthroplasty8 (2012): 61-5.e1.
  53. Bozic KJ., et al. “The epidemiology of revision total knee arthroplasty in the United States”. Clinical Orthopaedics and Related Research1 (2010): 45-51.

Citation

Citation: Mohamed Hashem and Hatem Hussein. “Periprosthetic Infection: Better Safe Than Sorry. Evidence-Based Scoping Review".Acta Scientific Orthopaedics 8.8 (2025): 30-37.

Copyright

Copyright: © 2025 Mohamed Hashem and Hatem Hussein. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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