Prevention of periprosthetic joint infection (PJI): a clinical practice protocol in high-risk patients

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• dc.contributor.author Iannotti, Ferdinando
• dc.contributor.author Prati, Paolo
• dc.contributor.author Fidanza, Andrea
• dc.contributor.author Iorio, Raffaele
• dc.contributor.author Ferretti, Andrea
• dc.contributor.author Pérez-Prieto, Daniel
• dc.contributor.author Kort, Nanne
• dc.contributor.author Violante, Bruno
• dc.contributor.author Pipino, Gennaro
• dc.contributor.author Schiavone Panni, Alfredo
• dc.contributor.author Hirschmann, Michael
• dc.contributor.author Mugnaini, Marco
• dc.contributor.author Indelli, Pier Francesco
• dc.date.accessioned 2022-02-25T07:37:43Z
• dc.date.available 2022-02-25T07:37:43Z
• dc.date.issued 2020
• dc.description.abstract Background: Periprosthetic joint infection (PJI) represents 25% of failed total knee arthroplasties (TKA). The European Knee Associates (EKA) formed a transatlantic panel of experts to perform a literature review examining patient-related risk factors with the objective of producing perioperative recommendations in PJI high-risk patients. Methods: Multiple databases (Pubmed/MEDLINE, EMBASE, Scopus, Cochrane Library) and recommendations on TKA PJI prevention measures from the International Consensus Meetings on PJI from the AAOS and AAHKS were reviewed. This represents a Level IV study. Results: Strong evidence was found on poor glycemic control, obesity, malnutrition, and smoking being all associated with increased rates of PJI. In the preoperative period, patient optimization is key: BMI < 35, diet optimization, Hemoglobin A1c < 7.5, Fructosamine < 292 mmol/L, smoking cessation, and MRSA nasal screening all showed strong evidence on reducing PJI risk. Intraoperatively, a weight-based antibiotic prophylaxis, accurate fluid resuscitation, betadine and chlorhexidine dual skin preparation, diluted povidone iodine solution irrigation, tranexamic acid administration, and monofilament barbed triclosan-coated sutures for soft tissues closure all represented effective prevention measures. In the postoperative period, failure to reach normalization of ESR, CRP, D-dimer, and IL-6 six weeks postoperatively suggested early PJI. Conclusion: The current recommendations from this group of experts, based on published evidence, support risk stratification to identify high-risk patients requiring implementation of perioperative measures to reduce postoperative PJI.
• dc.format.mimetype application/pdf
• dc.identifier.citation Iannotti F, Prati P, Fidanza A, Iorio R, Ferretti A, Pèrez Prieto D, et al. Prevention of periprosthetic joint infection (PJI): a clinical practice protocol in high-risk patients. Trop Med Infect Dis. 2020 11; 5(4): 186. DOI: 10.3390/tropicalmed5040186
• dc.identifier.doi http://dx.doi.org/10.3390/tropicalmed5040186
• dc.identifier.issn 2414-6366
• dc.identifier.uri http://hdl.handle.net/10230/52576
• dc.language.iso eng
• dc.publisher MDPI
• dc.rights © Iannotti, Ferdinando; Prati, Paolo; Fidanza, Andrea; Iorio, by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword DAPRI
• dc.subject.keyword PJI
• dc.subject.keyword TKA
• dc.subject.keyword Hip
• dc.subject.keyword Infection
• dc.subject.keyword Kknee
• dc.subject.keyword Local delivery
• dc.subject.keyword Musculoskeletal infections
• dc.subject.keyword Periprosthetic joint infections
• dc.subject.keyword Prevention
• dc.subject.keyword Septic loosening
• dc.title Prevention of periprosthetic joint infection (PJI): a clinical practice protocol in high-risk patients
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion