Risk factors for periprosthetic joint infection following primary total hip or knee arthroplasty: a meta-analysis

To identify risk factors for periprosthetic joint infection following primary total joint arthroplasty, a systematic search was performed in Pubmed, Embase and Cochrane library databases. Pooled odds ratios (ORs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Patient characteristics, surgical-related factors and comorbidities, as potential risk factors, were investigated. The main factors associated with infection after total joint arthroplasty (TJA) were male gender (OR, 1.48; 95% CI, 1.19-1.85), age (SMD, -0.10; 95% CI, -0.17--0.03), obesity (OR, 1.54; 95% CI, 1.25-1.90), alcohol abuse (OR, 1.88; 95% CI, 1.32-2.68), American Society of Anesthesiologists (ASA) scale> 2 (OR, 2.06; 95% CI, 1.77-2.39), operative time (SMD, 0.49; 95% CI, 0.19-0.78), drain usage (OR, 0.36; 95% CI, 0.18-0.74), diabetes mellitus (OR, 1.58; 95% CI, 1.37-1.81), urinary tract infection (OR, 1.53; 95% CI, 1.09-2.16) and rheumatoid arthritis (OR, 1.57; 95% CI, 1.30-1.88). Among these risk factors, ASA score> 2 was a high risk factor, and drain usage was a protective factor. There was positive evidence for some factors that could be used to prevent the onset of infection after TJA.