Arthroplasties evaluated: elbow, hip and knee
General risk factors:
(1) rheumatoid arthritis
(2) defect in host defenses (susceptible)
(3) delay in diagnosis
(4) delay in institution of appropriate therapy
Risk factors for early infection:
(1) problem with prophylactic antibiotics (overly narrow spectrum, dosing, timing)
(2) intra-operative contamination
(3) failure of wound healing
(4) urinary tract infection
(5) surgical site infection
(6) previously infected joint
Risk factors for late infection:
(1) late bacterial seeding from a distant site
(2) poor integrity of the bone-cement interface (loose prosthesis)
(3) difficult revision surgery due to scarring, large areas of dead space, devitalized tissue and other problems
Risk factors specific for elbow:
(1) metal-to-plastic elbow prosthesis
(2) posterior surgical approach
Risk factors specific for hip:
(1) revision of a previous operation
Risk factors specific for knee:
(1) cemented metal-to-metal hinged prosthesis
(2) synovitis with effusion
One key conclusion of the paper is that a patient with a total joint arthroplasty should be considered of being at risk of infection for the remainder of their lives.
