Perioperative periprosthetic joint infection prevention in total hip and knee replacement: European consensus
UK: A recent study in the Journal of Clinical Medicine reports one European consensus on the prevention of periprosthetic joint infection in total hip and knee replacement.
Periprosthetic joint infection (PJI) is a devastating complication in total hip and knee replacement. Its prevention is critical to decrease the incidence and avoid some consequences that seriously affect patients and health systems. Considering the variety of recommendations and guidelines, Basilio J. De la Torre, University of Alcalá, Madrid, Spain, and the team conducted an expert, peer-reviewed European consensus analysis about the pre-, intra-, and postoperative prevention of PJI. A series of 47 consensus statements were developed by a multinational group of practicing orthopedic experts in 6 main groups of intervention, and a 2-stage Delphi approach was launched with a threshold for agreement at 75% and for very high agreement at more than 90%. A total of 306 orthopedic surgeon responses were gathered from 9 countries. The consensus was reached for 42/47 statements, 31/47 of which achieved a very high consensus.
In hip and knee surgery, the following measures are recommended to minimize the risk of PJI:
- Patient education should involve skin cleaning techniques using a remnant antiseptic solution
- Patient education should involve skin cleaning techniques using a remnant antiseptic solution
- Alcoholic chlorhexidine offers greater protection than alcoholic povidone-iodine against PJI
- Alcohol-based solutions should be used in surgical hand preparation
- A standardized approach to the use of antiseptics should be in place, with particular attention to the incision site
- Antibiotic prophylaxis should be administered prior to surgery and not routinely prolonged
- Traffic and number of personnel in the operating room should be kept to a minimum
- Tranexamic acid and hemostatic agent use should be optimized to reduce the need for a surgical drain
- Structured surveillance and reporting protocols for PJI should be in place
- Specific guidelines for PJI should be developed and implemented; these should be tailored to individual patient risk factors
- Guidelines based on level 1 or 2 evidence should be considered mandatory
- Infections that appear 30 days post-surgery may still be considered to be PJI.
"This study confirms an important consensus among orthopedic surgeons across Europe in many areas well known to contribute to the prevention of PJI; however, there are still grounds for improvement," the authors concluded.
Reference:
Gómez-Barrena, E.; Warren, T.; Walker, I.; Jain, N.; Kort, N.; Loubignac, F.; Newman, S.; Perka, C.; Spinarelli, A.; Whitehouse, M.R.; Zagra, L.; De la Torre, B.J. Prevention of Periprosthetic Joint Infection in Total Hip and Knee Replacement: One European Consensus. J. Clin. Med. 2022, 11, 381. https://doi.org/10.3390/jcm11020381
