Table 2.
Pre-operative modifiable and non-modifiable risk factors; measures the surgeon can adopt to reduce impact of risk factors on development of PJI
| Non-modifiable risk factor | Conditions favouring PJI | Role of the surgeon |
|---|---|---|
| Obesity13,14 | BMI > 40 Kg/m2 | Weight loss Antibiotic adaptation |
| Anemia15 | Blood transfusion | Iron supplementation; erythropoietin therapy |
| Nutritional status10 | Serum albumin level < 34g/l Low total lymphocyte levels |
Correction of abnormal laboratory parameters |
| Diabetes16,17 | HbA1c level > 8 Fasting blood glucose level of 200 mg/dL |
Accurate peri-operative monitoring of blood glucose |
| Smoking11,18 | >1 pack/day or 25 cigarettes | Cessation between four and six weeks before surgery |
| Oral corticosteroid therapy12 | Steroid doses over 15 mg/day | Reduction or suspension |
| Rheumatoid arthritis19 | Steroid doses over 15 mg/day Other immunosoppressive agents (cyclophosphamide, methotrexate) |
Reduction or suspension of immunosoppressive therapy with reumatologist collaboration |
| Modifiable risk factor | Correlation with PJI incidence | Role of the surgeon |
| Urinary tract infection23-25 | Unclear | Delay surgery when urine leukocytes count > 1 × 10(4)/mL and bacterial count > 1 × 10(3)/mL |
| Intra-articular corticosteroid injections20,21 | Unclear | Surgical delay of between six and 12 months |
| Nasal colonisation with S. aureus26-28 | Influencing, predisposing | Nasal MRSA bonification with mupirocin application (debated efficacy) |
PJI, peri-prosthetic joint infections; BMI, body mass index; HbA1c, glycated haemoglobin; MRSA, methicillin-resistant staphylococcus aureus; S. aureus, staphylococcus aureus