a4de6684e4e24e9edd39549aedafb665 pmc_33322463.pdf f096a71ceafe751fd1939e90485db41306e113d7 pmc_33322463.pdf 9ea38a7b595d8047f89ad2053ef50adf0b4904035cfdf8da4f2d9b2bc8da0e2b pmc_33322463.pdf Title: Prevention of Periprosthetic Joint Infection (PJI): A Clinical Practice Protocol in High-Risk Patients Subject: Background: Periprosthetic joint infection (PJI) represents 25% of failed total knee arthroplasties (TKA). The European Knee Associates (EKA) formed a transatlantic panel of experts to perform a literature review examining patient-related risk factors with the objective of producing perioperative recommendations in PJI high-risk patients. Methods: Multiple databases (Pubmed/MEDLINE, EMBASE, Scopus, Cochrane Library) and recommendations on TKA PJI prevention measures from the International Consensus Meetings on PJI from the AAOS and AAHKS were reviewed. This represents a Level IV study. Results: Strong evidence was found on poor glycemic control, obesity, malnutrition, and smoking being all associated with increased rates of PJI. In the preoperative period, patient optimization is key: BMI < 35, diet optimization, Hemoglobin A1c < 7.5, Fructosamine < 292 mmol/L, smoking cessation, and MRSA nasal screening all showed strong evidence on reducing PJI risk. Intraoperatively, a weight-based antibiotic prophylaxis, accurate fluid resuscitation, betadine and chlorhexidine dual skin preparation, diluted povidone iodine solution irrigation, tranexamic acid administration, and monofilament barbed triclosan-coated sutures for soft tissues closure all represented effective prevention measures. In the postoperative period, failure to reach normalization of ESR, CRP, D-dimer, and IL-6 six weeks postoperatively suggested early PJI. Conclusion: The current recommendations from this group of experts, based on published evidence, support risk stratification to identify high-risk patients requiring implementation of perioperative measures to reduce postoperative PJI. Keywords: TKA; PJI; periprosthetic joint infections; knee; hip; infection; prevention; DAPRI; musculoskeletal infections; local delivery; septic loosening Author: Ferdinando Iannotti, Paolo Prati, Andrea Fidanza, Raffaele Iorio, Andrea Ferretti, Daniel Pèrez Prieto, Nanne Kort, Bruno Violante, Gennaro Pipino, Alfredo Schiavone Panni, Michael Hirschmann, Marco Mugnaini and Pier Francesco Indelli Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Dec 24 07:35:36 2020 CET ModDate: Thu Dec 24 07:40:46 2020 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 12 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 311482 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- WYEKQU+VnURWPalladioL-Bold Type 1 Custom yes yes no 10 0 JPHEHJ+VnURWPalladioL Type 1 Custom yes yes no 15 0 BXKJAV+URWPalladioL-Ital Type 1 Custom yes yes no 19 0 ASHIUV+URWPalladioL-Bold Type 1 Custom yes yes no 24 0 LZDGTK+Rpxb Type 1 Builtin yes yes no 28 0 VWQQAV+URWPalladioL-Roma Type 1 Custom yes yes no 32 0 OFLXAT+Rpxr Type 1 Builtin yes yes no 36 0 ZMZZBL+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 44 0 MCBCCI+SourceSansRoman-Regular Type 1C Custom yes yes no 66 0 MCBCCM+SourceSansRoman.613wght Type 1C Custom yes yes no 70 0 MCBCCO+SourceSansRoman-Bold Type 1C Custom yes yes no 74 0 SUTKTQ+Pxsy Type 1 Builtin yes yes no 84 0 OVNEXW+EURM10 Type 1 Builtin yes yes no 91 0 VSHNAE+Rpcxr Type 1 Builtin yes yes no 120 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2024-10-02 04:00:26 CEST RepresentationInformation: pmc_33322463.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2023-03-31 11:47:40 CEST Size: 311482 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 382 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: section.1 Item: Title: Preoperative Factors Increasing PJI Risk Destination: section.2 Children: Item: Title: Obesity Destination: subsection.2.1 Item: Title: Malnutrition Destination: subsection.2.2 Item: Title: Diabetes Mellitus Destination: subsection.2.3 Item: Title: Smoking Destination: subsection.2.4 Item: Title: Skin Decolonization Prior to Surgery Destination: subsection.2.5 Item: Title: Nasal Decolonization Destination: subsection.2.6 Item: Title: Intraoperative and Perioperative Factors Increasing PJI Risk Destination: section.3 Children: Item: Title: Surgical Site Hair Removal Destination: subsection.3.1 Item: Title: Perioperative Antibiotics Destination: subsection.3.2 Item: Title: Perioperative Antibiotics Timing Destination: subsection.3.3 Item: Title: Surgical Site Skin Decolonization Destination: subsection.3.4 Item: Title: Intraarticular Irrigation Destination: subsection.3.5 Item: Title: Fibrinolytic Agents Destination: subsection.3.6 Item: Title: Wound Closure Destination: subsection.3.7 Item: Title: Implant Surfaces Destination: subsection.3.8 Item: Title: Local Antibiotic Delivery Destination: subsection.3.9 Item: Title: Postoperative Factors increasing PJI Risk Destination: section.4 Item: Title: Protocol for PJI Prevention in High-Risk Patients Destination: section.5 Children: Item: Title: Risk Calculator Destination: subsection.5.1 Children: Item: Title: Preoperative Measures Destination: subsubsection.5.1.1 Item: Title: Intraoperative Measures Destination: subsubsection.5.1.2 Item: Title: Postoperative Measures Destination: subsubsection.5.1.3 Item: Title: Conclusions Destination: section.6 Item: Title: References Destination: section.6 Info: Title: Prevention of Periprosthetic Joint Infection (PJI): A Clinical Practice Protocol in High-Risk Patients Author: Ferdinando Iannotti, Paolo Prati, Andrea Fidanza, Raffaele Iorio, Andrea Ferretti, Daniel Pèrez Prieto, Nanne Kort, Bruno Violante, Gennaro Pipino, Alfredo Schiavone Panni, Michael Hirschmann, Marco Mugnaini and Pier Francesco Indelli Subject: Background: Periprosthetic joint infection (PJI) represents 25% of failed total knee arthroplasties (TKA). The European Knee Associates (EKA) formed a transatlantic panel of experts to perform a literature review examining patient-related risk factors with the objective of producing perioperative recommendations in PJI high-risk patients. Methods: Multiple databases (Pubmed/MEDLINE, EMBASE, Scopus, Cochrane Library) and recommendations on TKA PJI prevention measures from the International Consensus Meetings on PJI from the AAOS and AAHKS were reviewed. This represents a Level IV study. Results: Strong evidence was found on poor glycemic control, obesity, malnutrition, and smoking being all associated with increased rates of PJI. In the preoperative period, patient optimization is key: BMI < 35, diet optimization, Hemoglobin A1c < 7.5, Fructosamine < 292 mmol/L, smoking cessation, and MRSA nasal screening all showed strong evidence on reducing PJI risk. Intraoperatively, a weight-based antibiotic prophylaxis, accurate fluid resuscitation, betadine and chlorhexidine dual skin preparation, diluted povidone iodine solution irrigation, tranexamic acid administration, and monofilament barbed triclosan-coated sutures for soft tissues closure all represented effective prevention measures. In the postoperative period, failure to reach normalization of ESR, CRP, D-dimer, and IL-6 six weeks postoperatively suggested early PJI. Conclusion: The current recommendations from this group of experts, based on published evidence, support risk stratification to identify high-risk patients requiring implementation of perioperative measures to reduce postoperative PJI. 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