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Medical Optimization of the Patient Prior to Surgery

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Infection in Knee Replacement

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Abstract

Periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is a cause of major concern for the health systems and patients and remains the most common cause for early revision in practically every joint registry. It is associated with an increased financial burden, inferior clinical outcomes and increased morbidity. Although the incidence of PJI is relatively low, it adds significantly to the healthcare costs, as these patients have increased hospital stays, require readmissions and additional surgical procedures. Many risk factors associated with the PJI after TKA have been identified and can broadly be categorized into preoperative, intraoperative and post-operative factors. The mortality rate of a two-stage revision arthroplasty done for PJI approaches 25–33% at 5 years. Surgeons should attempt to decrease this risk by managing the modifiable risk factors. Screening should be performed 4–6 weeks prior to planned surgery to avoid the difficult decision for the clinician and the patient to postpone surgery in the anaesthetic bay. Involving the patient in the decision-making process by making the patient aware of the available options to optimize the risk factors prior to TKA is appropriate and to proceed with TKA when the patient is in as good a condition as is possible. Patients should be made aware that without optimization there is an increased chance of suffering from a PJI. A balanced clinical decision requires respect for the patients’ autonomy at the same time acting in their best interests to do no harm (Non-maleficence). This will minimize length of stay and additional surgical procedures for wound problems after joint arthroplasty and reduce readmission rates to avoid financial constraints on the healthcare providers.

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Authors and Affiliations

  1. Sydney Orthopaedic and Research Institute, Sydney, Australia

    Claire Bolton, Vikram Kandhari & Myles Coolican

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  1. Claire Bolton
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  2. Vikram Kandhari
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  3. Myles Coolican
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Correspondence to Myles Coolican .

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Editors and Affiliations

  1. Università Campus Bio-Medico di Roma, Rome, Italy

    Umile Giuseppe Longo

  2. Arthroplasty & Sports Medicine, Nicolaas Institute of Constructive Orthopedic Research, Jakarta, Indonesia

    Nicolaas C. Budhiparama

  3. Département de Chirurgie Orthopédiq, Hôpital de la Croix-Rousse, Lyon Cedex 04, France

    Sébastien Lustig

  4. Department of Orthopaedics and Traumatology, Center of Joint Replacement, Medical Director of the University Hospital, University of Brandenburg an der Havel, Brandenburg, Germany

    Roland Becker

  5. Clínica do Dragao - Espregueira-Mendes, Braga, Portugal

    João Espregueira-Mendes

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Bolton, C., Kandhari, V., Coolican, M. (2022). Medical Optimization of the Patient Prior to Surgery. In: Longo, U.G., Budhiparama, N.C., Lustig, S., Becker, R., Espregueira-Mendes, J. (eds) Infection in Knee Replacement. Springer, Cham. https://doi.org/10.1007/978-3-030-81553-0_24

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