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Contemporary Strategies to Prevent Infection in Hip and Knee Arthroplasty

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Abstract

Purpose of Review

Prosthetic joint infection (PJI) remains a serious concern in lower limb arthroplasty. Despite the significant consequences of PJI, the assessment of the safety and efficacy of preventative measures is challenging due to a low event rate. Notwithstanding, enormous efforts have been made in this arena, and prevention strategies continue to evolve. This review provides an update on contemporary literature (published within the last 5 years) pertaining to infection prevention in primary hip and knee arthroplasty.

Recent Findings

Patient optimization has been highlighted as a critical preoperative factor in mitigating PJI risk. Recent evidence emphasizes the importance of preoperative glycaemic control, nutritional status, weight optimization and smoking cessation prior to hip and knee arthroplasty. Perioperatively, attention to detail in terms of surgical skin preparation agent and technique as well as prophylactic antibiotic agent, spectrum, dose and timing is important with statistically and clinically significant differences seen between differing strategies. Intraosseous regional antibiotic administration is an emerging technique with promising preclinical data. Dilute betadine lavage also shows promise. Data supporting bundled interventions continues to grow.

Summary

A multimodal approach is required in PJI prevention, and attention to detail is important with each element. Patient optimization is critical, as is the execution of the planned perioperative infection prevention strategy.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

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Authors and Affiliations

  1. OrthoSport Victoria Research Unit, Epworth Hospital, 89 Bridge Rd, Richmond, Victoria, 3121, Australia

    Lachlan M. Batty

  2. Division of Orthopaedic Surgery, University Hospital, London Health Sciences Centre, Western University, London, Ontario, N6A 5A5, Canada

    Brent Lanting

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All authors made substantial contributions to the conception or design of the work, drafted the work or revised it critically for important intellectual content and approved the version to be published.

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Correspondence to Lachlan M. Batty.

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LB, not applicable. BL, personal fees from Smith & Nephew, Stryker, DePuy, Integra and Intellijoint and institutional support from Smith & Nephew, DePuy, Stryker and Zimmer, all outside the submitted work.

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Batty, L.M., Lanting, B. Contemporary Strategies to Prevent Infection in Hip and Knee Arthroplasty. Curr Rev Musculoskelet Med 13, 400–408 (2020). https://doi.org/10.1007/s12178-020-09653-9

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