Serbian Journal of Anesthesia and Intensive Therapy (Jan 2018)
Periprosthetic infection: Is everything done in aim of recognition and prevention? (Periprosthetic infection)
Abstract
Total hip and total knee arthroplasty improve quality of life and reduce pain in patients with severe joint diseases. Despite the widely reported success of the procedures, periprosthetic joint infection (PPI), as complication, affects approximately 1% of patients after joint arthroplasty leading to poor surgical outcomes, osteomyelitis, sepsis, multiorgan dysfunction and even death. The treatment includes timely performed open debridement and exchange of all mobile parts of the prosthesis and antibiotics that can prevent formatting bacterial biofilm over the implants surface or penetrate into them. Management of PPI is expensive and presents economic burden on the health care system. Therefore, prevention and identification of potential risk factors is of great importance. Patient related risk factors for PPI include gender, alcohol abuse, higher body mass index, cardiovascular, pulmonary, renal, gastrointestinal, rheumatological and oncological disease, diabetes, immunosuppression, preoperative infection and depression. Moreover, perioperative complications, other conditions like hypothermia, longer hospital stay, blood transfusion and reoperation also increase risk for PPI. PPI prevention measures need to be implemented in the preoperative, perioperative and postoperative period. Preventive measures include nasal decolonization, preoperative skin cleansing, reduced doses of intraarticular injections and immunosuppressive therapy, glycemic control, antibiotic prophylaxis, laminar air flow, orthopedic space suits, operating theatre traffic, surgical site preparation, normothermia, the use of erythropoietin and tranexamic acid.
