Abstract
Total hip arthroplasty (THA) is a very successful and effective operation for the restoration of the hip function. The number of operations is steadily climbing and is going to reach new heights in the future. The most feared and devastating complication is the periprosthetic joint infection (PJI) and has in most cases to be treated with a total revision of the prostheses. The risk factors for a PJI are playing a very important role in the preoperative assessment of the patient and for the type of antibiotic treatment. There are many risk factors described in the literature, which are associated with the development of a PJI. Our goal was to analyze and find the relevant risk factors, which matter most in joint replacement surgery. We searched the database PubMed and Embase with the keywords: ((hip AND infection) AND (arthroplasty OR replacement)). With the help of check lists and limits we extracted the most viable studies for our research. Risk factors associated with a deep periprosthetic joint infection included the BMI (Body mass index), male gender, prolonged duration of surgery, diabetes mellitus type 2, the ASA (American society of anesthesiologists) score, the Charlson score and the NNIS (National Nosocomial Infections Surveillance System) risk index score. Female gender, age and the diagnosis of rheumatoid arthritis were not associated with a higher risk of periprosthetic joint infections. Patients with risk factors should be assessed and informed preoperatively and should receive an appropriate prophylactic antibiotic treatment, to reduce the risk of a PJI. With the reduction of their weight and adjustment of the diabetes, patients can reduce the risk for PJI by their own. Total hip replacement is still a very safe and effective operation and therefore should not be withheld from patients.
Highlights
The total hip arthroplasty evolved from a difficult and expensive operation to a very cost efficient restoration of the hip function and treatment of pain
We asked us why an elevated BMI score can lead to an increased risk of Periprosthetic joint infections (PJI)
Motaghedi et al (2014) reported an increased postoperative rate of interleukin (IL) 1β and 6 as well as the tumor necrosis factor α (TNF) in obese patients after a Total hip arthroplasty (THA). These inflammatory factors are produced in the white fat cells and trigger neutrophil granulocytes which lead to an inflammatory reaction. [27, 28]
Summary
The total hip arthroplasty evolved from a difficult and expensive operation to a very cost efficient restoration of the hip function and treatment of pain. Periprosthetic joint infections (PJI) is by far the most devastating and severe complication with an incidence between 0.5 and 3% in primary surgery. While a primary total hip arthroplasty in Germany costs 6.263€ in average, the expenses rise to 29.331€ when the patient develops a PJI. The goal of this study was to find published studies regarding the deep periprosthetic infection, to compare and evaluate their results. Through these we would be able to reduce the number of infections and save many patients from suffering pain
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