Diagnosis and Prevention of Periprosthetic Joint Infections

A. Moderate strength evidence supports that obesity is associated with increased risk of PJI. (M)

B. Limited strength evidence supports that patients in which one or more of the following criteria are present are at an increased risk of periprosthetic joint infection after hip and knee arthroplasty:

• Cardiac disease (arrhythmia, CAD, congestive heart failure, other)
• Immunocompromised status (other than HIV), including transplant, cancer
• Peripheral vascular disease
• Inflammatory arthritis
• Prior joint infection
• Renal disease
• Liver disease (hepatitis, cirrhosis, other)
• Mental health disorders (including depression)
• Alcohol use
• Anemia
• Tobacco use
• Malnutrition
• Diabetes
• Uncontrolled diabetes

(L)

C. In the absence of reliable evidence, it is the opinion of this work group that in the case thatone or more of the following conditions are present, the practitioner should carefully consider the risk before proceeding with surgery:

• Active infection (strongly caution against proceeding with surgery given the risks)
• Anticoagulation status, active thromboprophylaxis (proceed only after careful consideration of the risks)
• Autoimmune disease (proceed only after careful consideration of the risks)
• HIV status (proceed only after careful consideration of the control and risks)
• Institutionalized patients (proceed only after careful consideration of the risks)
• Prior bariatric surgery (proceed only after careful consideration of the risks)

(C)

D. In the absence of reliable evidence, it is the opinion of this work group that the following conditions have an unclear effect on risk of PJI:

• Age (conflicting evidence)
• Dementia (insufficient evidence due to imprecise confidence intervals)
• Poor dental status (insufficient evidence for a recommendation)
• Asymptomatic bacteriuria (conflicting evidence)

(C)