Circumstances that Increase the Risk of Periprosthetic Joint Infection after Total Knee Arthroplasty

According to recent publications there are some circumstances that increase the risk of periprosthetic joint infection (PJI) following total knee arthroplasty (TKA). They are the following: 1) Individuals who experience arthroscopic lysis of adhesions after TKA due to postoperative arthrofibrosis have higher rates of PJI than those who do not. 2) Rheumatoid arthritis individuals have higher risks of PJI than osteoarthritis patients. 3) At 2 years, the rate of PJI is significantly higher in the patients having chronic anticoagulation (CA) than in patients not having CA. 4) Cefazolin prophylaxis significantly diminishes 90-day PJI risk following TKA compared to other antibiotics. 5) The frequency of PJI is significantly inferior in patients receiving intraosseus (IO) vancomycin than in patients receiving intravenous vancomycin at 1-month, 3-month, and 1-year follow-up. 6) Cellulitis is a risk factor for PJI following TKA, particularly when it happens within a year of surgery. 7) Individuals who have preoperative anemia (hemoglobin of 10 g/dL) have a 1.86-fold greater risk of PJI. 8) A clostridium difficile infection within 2 years prior to TKA is associated with greater probability of PJI. 9) Individuals experiencing TKA who have hypoalbuminemia (albumin < 3.1 g/dL) before surgery are at higher risk of PJI. 10) It is still unclear whether intraarticular injections before TKA implantation increase the risk of PJI after surgery, as publications on the subject have reached conflicting conclusions. Given that the level of evidence in the published studies is not very high, all the conclusions mentioned here must be confirmed by studies with higher level of evidence.

Level of evidence: III-IV.