Jaaos-d-12-00170 356..364

Periprosthetic joint infections are devastating complications that are difficult and expensive to treat and have a substantial mortality rate. A major goal of modern joint arthroplasty is to minimize these infections. Preoperative factors associated with increased risk of infection include malnutrition, diabetes mellitus, obesity (body mass index.40 kg/m2), and rheumatoid arthritis. Administration of appropriate antibiotics before the surgical incision is made is essential to minimize infection. The use of laminar flow rooms, proper skin preparation, limiting operating room traffic, and the use of various wound closure techniques can help to decrease infection rates. Postoperatively, optimal management of indwelling urinary catheters, blood transfusions, and wound drainage also may decrease infection rates. The individual morbidity and societal cost associated with periprosthethic joint infections make them devastating postoperative complications.1 Total knee arthroplasty (TKA) infection rates range from 1.1% to 2.20%.2,3 Despite this relatively low incidence, infections remain a significant cause of reoperation. A review of 60,355 revision TKA cases from the National Inpatient Sample database demonstrated that infection was the leading indication for revision TKA (25.2%).4 Hanssen and Rand5 noted that, at the Mayo Clinic between 1969 and 1996, the prevalence of infection after total hip arthroplasty (THA) and TKA was 1.7 % and 2.5%, respectively (30,680 THAs, 18,749 TKAs). Despite the use of different antibiotic prophylactic regimens, operating room (OR) configurations, surgical techniques, and modes of fixation, the authors noted that the rate of infection was remarkably constant at their institution.5 Here, we describe the risk factors associated with periprosthetic joint infection and strategies for preventing infection. Preoperative Risk Factors Preoperative factors associatedwith an increased risk of infection include nutritionaldeficiencies,6,7 uncontrolled diabetes mellitus,8,9 obesity,6-8,10 male sex,2,11,12 longer surgical time,12 and rheumatoid arthritis11 (Table 1). Nutritional Deficiency Assessing the patient’s nutritional status before elective surgery is essential. Greene et al13 reviewed the records of 217 patients who underwent a primary THA or TKA. The risk of developing a major wound complication was five times greater in patients with a preoperative lymphocyte count of ,1,500 cells/mm3. The risk of wound complications was seven times greater in patients with an albumin level of ,5 g/dL. Jaberi et al14 retrospectively reviewed 300 patients who underwent total joint 356 Journal of the American Academy of Orthopaedic Surgeons Brian K. Daines, MD Douglas A. Dennis, MD