Abstract
Prosthetic joint infection (PJI) is a devastating complication following total joint replacement that leads to excess morbidity, mortality, and cost. This chapter has outlined effective prevention strategies that may be utilized in all phases of perioperative care. A multifaceted approach to the patient undergoing total joint replacement will have the greatest positive effect. Further study will be needed to identify and share “best practice” models that might be emulated to lower the PJI risk for all patients.
Keywords
- Surgical Site Infection
- Periprosthetic Joint Infection
- Prosthetic Joint Infection
- Total Joint Replacement
- Staph Aureus
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Urquhart DM, Hanna FS, Brennan SL, Wluka AE, Leder K, Cameron PA, Graves SE, Cicuttini FM. Incidence and risk factors for deep surgical site infection after primary total hip arthroplasty: a systemic review. J Arthroplasty. 2009;25:1216–22.
Ong KL, Kurtz SM, Lau E, Bozic KJ, Berry DJ, Parvizi J. Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. J Arthroplasty. 2009;24(6 Suppl):105–9.
Berbari EF, Hanssen AD, Duffy MC, Steckelberg JM, Ilstrup DM, Harmsen WS, Osmon DR. Risk factors for prosthetic join infection, case–control study. Clin Infect Dis. 1998;27:1247–54.
Bozic KJ, et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res. 2010;468(1):45–51.
Bozic KJ, et al. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91(1):128–33.
Clohisy JC, Calvert G, Tull F, McDonald D, Maloney WJ. Reasons for revision hip surgery: a retrospective review. Clin Orthop Relat Res. 2004;429:188–92.
Kurtz SM, Lau E, Schmier J, Ong KL, Zhao K, Parvizi J. Infection burden for hip and knee arthroplasty in the United States. J Arthroplasty. 2008;23:984–91.
Sharkey PF, Hozack WJ, Rothman RH, Shastri S, Jacoby SM. Why are total knee arthroplasties failing today? Clin Orthop Relat Res. 2002;404:7–13.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89:780–5.
Pulido L, Ghanem E, Joshi A, Purtill JJ, Parvizi J. Periprosthetic joint infection: the incidence, timing and predisposing factors. Clin Orthop Relat Res. 2008;466:1710–5.
Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J. Prosthetic joint infection risk after TKA in Medicare population. Clin Orthop Relat Res. 2010;468:52–6.
Jämsen E, Huhtala H, Puolakka T, Moilanen T. Risk factors for infection after knee arthroplasty. A register-based analysis of 43,149 cases. J Bone Joint Surg Am. 2009;91:38–47.
Lai K, Bohm ER, Burnell C, Hedden DR. Presence of medical comorbidities in patients with infected primary hip or knee arthroplasties. J Arthroplasty. 2007;22:651–6.
Jain NB, Guller U, Pietrobon R, Bond TK, Higgins LD. Comorbidities increase complication rates in patients having arthroplasties. Clin Orthop Relat Res. 2005;435:232–8.
Greene KA, Wilde AH, Stulberg BN. Preoperative nutritional status of total join patients. Relationship to postoperative wound complications. J Arthroplasty. 1991;6:321–5.
Dickhaut SC, DeLee JC, Page CP. Nutritional status: importance in predicting wound-healing after amputation. J Bone Joint Surg Am. 1984;66(1):71–5.
Bushnell BD, Horton JK, McDonald MF, Robertson PG. Preoperative medical comorbidities in the orthopaedic patient. J Am Acad Orthop Surg. 2008;16(4):216–27.
Argintar E, Triantafillou K, Delahay J, Wiesel B. The musculoskeletal effects of perioperative smoking. J Am Acad Orthop Surg. 2012;20(6):359–63.
Porter SE, Hanley Jr EN. The musculoskeletal effects of smoking. J Am Acad Orthop Surg. 2001;9(1):9–17.
Wilson MG, Kelley K, Thornhill TS. Infection as a complication of total knee replacement arthroplasty. Risk factors and treatment in sixty-seven cases. J Bone Joint Surg Am. 1990;72:878–83.
Liabaud B, Patrick Jr DA, Geller JA. Higher body mass index leads to longer operative time in total knee arthroplasty. J Arthroplasty. 2012;28(4):563–5.
Marchant Jr MH, Viens NA, Cook C, Vail TP, Bolognesi MP. The impact of glycemic control and diabetes mellitus on perioperative outcomes after total joint arthroplasty. J Bone Joint Surg Am. 2009;91(7):1621–9.
Mangram AJ, Horan TC, Pearson ML, et al. Guideline for prevention of surgical site infection. 1999. Hospital infection control practices advisory committee. Infect Control Hosp Epidemiol. 1999;20:250.
Anderson DJ, Sexton DJ, Kanalani ZA, et al. Severe surgical site infection in community hospitals: epidemiology, key procedures and the changing prevalence of methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol. 2007;28:1047.
Grundmann H, Aires-de-Souja M, Boyce J, et al. Emergence and resurgence of methicillin-resistant Staphylococcus aureus as a public-health threat. Lancet. 2006;368:874–85.
Kock R, Becker K, Cookson B, et al. Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe. Euro Surveill. 2010;15(41):19688.
Stamm AM, Long MN, Belcher B. Higher overall nosocomial infection rate because of increased attack rate of methicillin-resistant Staphylococcus aureus. Am J Infect Control. 1993;21:70–4.
Gonzalez BE, Rueda AM, Shelburne SA, et al. Community-associated strain of methicillin-resistant Staphylococcus aureus as the cause of healthcare –associated infection. Infect Control Hosp Epidemiol. 2006;27:1051–6.
Engemann JJ, Carmeli Y, Cosgrove SE, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis. 2003;36:592–8.
Wertheim HF, Melles DC, Vos MC, et al. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis. 2005;5:751–62.
Matheson A, Christie P, Stari T, et al. Nasal swab screening for methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol. 2012;33(8):803–8.
Ten Broeke-Smits NJ, Kummer JA, Bleys RL, et al. Hair follicles as a niche of Staphylococcus aureus in the nose; is a more effective decolonization strategy needed? J Hosp Infect. 2010;76:211–4.
Paule SM, Pasquariello AC, Hacek DM, et al. Direct detection of Staphylococcus aureus from adult and neonate nasal swab specimens using real-time polymerase chain reaction. J Mol Diagn. 2004;6:191–6.
Kluytmans J, van Belkum A, Verbrugh H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev. 1997;10:505.
Perl TM, Golub JE. New approaches to reduce Staphylococcus aureus nosocomial infection rates: treating S. aureus nasal carriage. Ann Pharmacother. 1998;32:57.
Wenzel RP, Perl TM. The significance of nasal carriage of Staphylococcus aureus and the incidence of postoperative wound infection. J Hospital Infect. 1995;31:13.
Kalmeijer MD, van Nieuwland-Bollen E, Bogaers-Hofman D, et al. Nasal carriage of Staphylococcus aureus is a major risk factor for surgical-site infections in orthopedic surgery. Infect Control Hosp Epidemiol. 2000;21:319.
West SK, Plantenga MS, Strausbaugh LJ. Use of decolonization to prevent staphylococcal infection in various healthcare settings: results of an Emerging Infections Network survey. Infect Control Hosp Epidemiol. 2007;28:1111–3.
Hansen S, Schwab F, Asensio A, et al. Methicillin-resistant Staphylococcus aureus (MRSA) in Europe: which infection control measures are taken? Infection. 2010;38:159–64.
Simor AE. Staphylococcal decolonization: an effective strategy for prevention of infection? Lancet Infect Dis. 2011;11:952–62.
Rao N, Cannella BA, Crossett LS, et al. Prospective screening/decolonization for Staphylococcus aureus to prevent orthopedic surgical site infection: prospective cohort study with 2-year follow-up. J Arthroplasty. 2011;26:1501–7.
Kim DH, Spencer M, Davidson SM, et al. Institutional pre-screening for detection and eradication of methicillin-resistant Staphylococcus aureus in patients undergoing elective orthopaedic surgery. J Bone Joint Surg Am. 2010;92:1820–6.
Rao N, Cannella B, Crossett LS, et al. A preoperative decolonization protocol for Staphylococcus aureus prevents orthopaedic infections. Clin Orthop Relat Res. 2008;466:1343–8.
Sankar B, Hopgood P, Bell KM. The role of MRSA screening in joint-replacement surgery. Int Orthop. 2005;29:160–3.
Wilcox MH, Hall J, Pike H, et al. Use of peri-operative mupirocin to prevent methicillin-resistant Staphylococcus aureus (MRSA) orthopedic surgical site infections. J Hosp Infect. 2003;54:196–201.
Hadley S, Immerman I, Hutzler L, et al. Staphylococcus aureus decolonization protocol decreases surgical site infections for total joint replacement. Arthritis. 2010;2010:924518.
Hacek DM, Robb WJ, Paule SM, et al. Staphylococcus aureus nasal decolonization in joint replacement surgery reduces infection. Clin Orthop Relat Res. 2008;466:1349–55.
Price CS, Williams A, Phillips G, et al. Staphylococcus aureus nasal colonization in pre-operative orthopaedic out patients. Clin Orthop Relat Res. 2008;466:2842–7.
Nixon M, Jackson B, Varghese P, et al. Methicillin-resistant Staphylococcus aureus on orthopaedic wards: incidence, spread, mortality, cost and control. J Bone Joint Surg Br. 2006;88:812–7.
Hassan K, Paturi A, Hughes C, et al. The prevalence of methicillin-resistant Staphylococcus aureus in orthopaedics in a non-selective screening policy. Surgeon. 2008;6:201–3.
Courville XF, Tomek IM, Kirkland KB, et al. Cost-effectiveness of preoperative nasal mupirocin treatment in preventing surgical site infection in patients undergoing total hip and knee arthroplasty: a cost-effectiveness analysis. Infect Control Hosp Epidemiol. 2012;33:152–9.
Lee BY, Wiringa AE, Bailey RR, et al. The economic effect of screening orthopedic surgery patients preoperatively for methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol. 2010;31:1130–8.
Slover J, Haas JP, Quirno M, et al. Cost-effectiveness of a Staphylococcus aureus screening and decolonization program for high-risk orthopedic patients. J Arthroplasty. 2011;26:360–5.
Alexander JW, Fischer JE, Boyajian M, Palmquist J, Morris MJ. The influence of hair-removal methods on wound infections. Arch Surg. 1983;118:347–52.
Balthazar ER, Colt JD, Nichols RL. Preoperative hair removal: a random prospective study of shaving versus clipping. South Med J. 1982;75:799–801.
Tanner J, Woodings D, Moncaster K. Preoperative hair removal to reduce surgical site infection. Cochrane Database Syst Rev. 2006;2, CD004122.
Matar WY, Jafari SM, Restrepo C, Austin M, Purtill JJ, Parvizi J. Preventing infection in total joint arthroplasty. J Bone Joint Surg Am. 2010;92:36–46.
Grove GL, Eyberg C. Comparison of two preoperative skin antiseptic preparations and resultant surgical incise drape adhesion to skin in healthy volunteers. J Bone Joint Surg Am. 2012;94:1187–92.
Fletcher N, Sofianos D, Berkes MB, Obremskey WT. Prevention of perioperative infection. J Bone Joint Surg Am. 2007;89:1605–18.
Owers KL, James E, Bannister GC. Source of bacterial shedding in laminar flow theatres. J Hosp Infect. 2004;58:230–2.
Hubble MJ, Weale AE, Perez JV, Bowker KE, MacGowan AP, Bannister GC. Clothing in laminar-flow operating theatres. J Hosp Infect. 1996;32:1–7.
Parienti JJ, Thibon P, Heller R, Le Roux Y, von Theobald P, Bensadoun H, Bouvet A, Lemarchand F, Le Coutour X. Hand-rubbing with an aqueous alcoholic solution vs traditional surgical hand-scrubbing and 30-day surgical site infection rates: a randomized equivalence study. J Am Med Assoc. 2002;288:722–7.
Bryce E, Spence D, Roberts FJ. An in-use evaluation of an alcohol-based pre-surgical hand disinfectant. Infect Control Hosp Epidemiol. 2001;22:635–9.
Pereira LJ, Lee GM, Wade KJ. An evaluation of five protocols for surgical handwashing in relation to skin condition and microbial counts. J Hosp Infect. 1997;36:49–65.
Tanner J, Parkinson H. Double glove to reduce surgical cross-infection. Cochrane Database Syst Rev. 2006;3, CD003087.
Al-Maiyah M, Bajwa A, Mackenney P, Port A, Gregg PJ, Hill D, Finn P. Glove perforation and contamination in primary total hip arthroplasty. J Bone Joint Surg Br. 2005;87:556–9.
Knobben BA, van Horn JR, van der Mei HC, Busscher HJ. Evaluation of measures to decrease intra-operative contamination in orthopaedic implant surgery. J Hosp Infect. 2006;62:174–80.
Merrill A, Ritter MA, Olberding EM, Malinzak RA. Ultraviolet lighting during orthopedic surgery and the rate of infection. J Bone Joint Surg Am. 2007;89(9):1935–40.
Hanssen AD, Rand JA. Evaluation and treatment of infection at the site of a total hip or knee arthroplasty. J Bone Joint Surg Am. 1999;48:111–22.
Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res. 2009;468(1):52–6.
Peersman G, Laskin R, Davis J, Peterson M. Infection in total knee replacement, a retrospective review of 6489 total knee replacements. Clin Orthop Relat Res. 2001;392:15–23.
Bordin JO, Heddle NM, Blajchman MA. Biologic effect of leukocytes present in transfused cellular blood products. Blood. 1994;84(6):1703–21.
Vamvakas EC, et al. Transfusion associated cancer recurrence and postoperative infection: meta-analysis of randomized, controlled clinical trials. Transfusion. 1996;36(2):175–86.
Keating EM, Meding JB. Perioperative blood management practices in elective orthopedic surgery. J Am Acad Orthop Surg. 2002;10(6):393–400.
Prokuski L. Prophylactic antibiotics in orthopaedic surgery. J Am Acad Orthop Surg. 2008;16(5):283–93.
AlBuhairan B, Hind D, Hutchinson A. Antibiotic prophylaxis for wound infections in total join arthroplasty: a systemic review. J Bone Joint Surg Br. 2008;90:915–9.
Patzakis MJ, Wilkins J. Factors influencing infection rate in open fracture wounds. Clin Orthop Relat Res. 1989;243:36–40.
Periti P, Mini E, Mosconi G. Antimicrobial prophylaxis in orthopedic surgery: the role of teicoplanin. J Antimicrob Chemother. 1998;41:329–40.
Strausbaugh LJ, Crossley KB, Nurse BA, Thrupp LD. Antimicrobial resistance in long-term facilities. Infect Control Hosp Epidemiol. 1996;17:129–40.
Prokuski L. Prophylactic antibiotics in orthopaedic surgery. J Am Acad Orthop Surg. 2008;16:283–93.
Meehan J, Jamali AA, Nguyen H. Prophylactic antibiotics in hip and knee arthroplasty. J Bone Joint Surg Am. 2009;91:2480–90.
Kelkar PS, Li JT. Cephalosporin allergy. N Eng J Med. 2001;345:804–9.
Nelson CL, Green TG, Porter RA, Warren RD. One day versus seven days of preventive antibiotic therapy in orthopedic surgery. Clin Orthop Relat Res. 1983;176:258–63.
Williams DN, Gustilo RB. The use of preventive antibiotics in orthopedic surgery. Clin Orthop Relat Res. 1984;190:83–8.
Pollard JP, Hughes SP, Scott JE, Evans MJ, Benson MK. Antibiotic prophylaxis in total hip replacement. Br Med J. 1979;1:707–9.
Heydemann JS, Nelson CL. Short-term preventive antibiotics. Clin Orthop Relat Res. 1986;205:184–7.
Garcia S, Lozano ML, Gatell JM, Soriano E, Ramon R, Sanmiguel JG. Prophylaxis against infection. Single-dose cefonicid compared with multiple-dose cefamandole. J Bone Joint Surg Am. 1991;73:1044–8.
Jiranek WA, Hanssen AD, Greenwald AS. Antibiotic-loaded bone cement for infection prophylaxis in total joint replacement. J Bone Joint Surg Am. 2006;88:2487–500.
Espehaug B, Engesaeter LB, Vollset SE, Havelin LI, Langeland N. Antibiotic prophylaxis in total hip arthroplasty: review of 10,905 primary cemented total hip replacements reported to Norwegian arthroplasty registry, 1987 to 1995. J Bone Joint Surg Br. 1997;79(4):590–5.
Hope PG, Kristinsson KG, Norman P, Elson RA. Deep infection of cemented total hip arthroplasties caused by coagulase-negative staphylococci. J Bone Joint Surg Br. 1989;71(5):851–5.
Kalteis T, Lehn N, Schröder HJ, Schubert T, Zysk S, Handel M, Grifka J. Contaminant seeding in bone by different irrigation methods: an experimental study. J Orthop Trauma. 2005;19:591–6.
Draeger R, Dahners LE. Traumatic wound debridement: a comparison of irrigation methods. J Orthop Trauma. 2006;20:83–6.
Anglen JO, Apostoles S, Christensen G, Gainor B. Removal of surface bacteria by irrigation. J Orthop Research. 1996;14:251–4.
Anglen JO, Gainor BJ, Simpson WA, Christensen G. The use of detergent irrigation for musculoskeletal wounds. Int Orthop. 2003;27:40–6.
Manian FA, Meyer PL, Setzer J, Senkel D. Surgical site infections associated with methicillin-resistant Staphylococcus aureus: do postoperative factors play a role? Clin Infect Dis. 2003;36:863–8.
Lionelli GT, Lawrence WT. Wound dressings. Surg Clin North Am. 2003;83:617–38.
Cho CY, Lo JS. Dressing the part. Dermatol Clin. 1998;16:25–47.
Mertz PM, Marshall DA, Eaglstein WH. Occlusive wound dressings to prevent bacterial invasion and wound infection. J Am Acad Dermatol. 1985;12:662–8.
Hutchinson JJ, McGuckin M. Occlusive dressings: A microbiologic and clinical review. Am J Infect Control. 1990;18:257–68.
Mortazavi SM, Hansen P, Zmistowski B, Kane PW, Restrepo C, Parvizi J. Hematoma following primary total Hip arthroplasty: a grave complication. J Arthroplasty. 2012;28(3):498–503.
Parvizi J, Ghanem E, Joshi A, Sharkey PF, Hozack WJ, Rothman RH. Does “Excessive” anticoagulation predispose to periprosthetic infection? J Arthroplasty. 2007;22 Suppl 2:24–8.
Galat DD, McGovern SC, Hanssen AD, Larson DR, Harrington JR, Clarke HD. Early return to surgery for evacuation of a postoperative hematoma after primary total. J Bone Joint Surg Am. 2008;90(11):2331–6.
American Dental Association; American Academy of Orthopedic Surgeons. Antibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc. 2003;134:895–9.
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Potter, G.D., Rao, N., Mabry, T.M. (2014). Prevention of Periprosthetic Joint Infection. In: Springer, B., Parvizi, J. (eds) Periprosthetic Joint Infection of the Hip and Knee. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7928-4_3
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