Research progress on risk factors of surgical wound infection after total hip arthroplasty_West China Medical Journal

Authors：

CHANG Chengting ,  NING Ning

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

NING Ning, Email: gkningning@126.com

Keywords：

Total hip arthroplasty; Surgical wound infection; Risk factors

DOI：

10.7507/1002-0179.201907223

Video：

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Total hip arthroplasty (THA) is the mainstay of treatment for advanced hip arthritis, but a number of postoperative wound complications may occur, such as wound dehiscence, bleeding and infection. Among them, wound infection is one of the serious complications after THA, which may lead to hip dysfunction or even disability, prolong hospital stay, increase readmission rate and significantly increase related medical expenses. Therefore, further understanding and action to change modifiable risk factors associated with wound infection will not only reduce medical expenses, but also improve the prevention, treatment and care. This article reviews the risk factors of surgical wound infection over the past 5 years, including patients factors (serum albumin, serum transferrin, blood transfusion, congestive heart failure, diabetes, overweight or obesity, smoking, and long-term use of hormone) and medical factors (previous surgery, surgical approach, length of surgery, and operating room environment).

Citation： CHANG Chengting, NING Ning. Research progress on risk factors of surgical wound infection after total hip arthroplasty. West China Medical Journal, 2019, 34(9): 1059-1062. doi: 10.7507/1002-0179.201907223 Copy

1.	Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am, 2007, 89(4): 780-785.
2.	Derman PB, Fabricant PD, David G. The role of overweight and obesity in relation to the more rapid growth of total knee arthroplasty volume compared with total hip arthroplasty volume. J Bone Joint Surg Am, 2014, 96(11): 922-928.
3.	Sueyoshi T, Meding JB, Davis KE, et al. Clinical predictors for possible failure after total hip arthroplasty. Hip Int, 2016, 26(6): 531-536.
4.	Pugely AJ, Martin CT, Gao Y, et al. The incidence of and risk factors for 30-day surgical site infections following primary and revision total joint arthroplasty. J Arthroplasty, 2015, 30(9 Suppl): 47-50.
5.	Public Health England. Surveillance of surgical site infections in NHS hospitals in England, 2017 to 2018. (2018-12-17)[2019-06-01]. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/765967/SSI_annual_report_NHS_hospitals_2017_18.pdf.
6.	谢章家, 庞安琪, 谢壮. 人工全髋关节置换术后早期手术部位感染的危险因素分析. 中华关节外科杂志(电子版), 2011, 5(4): 446-450.
7.	Kirkland KB, Briggs JP, Trivette SL, et al. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol, 1999, 20(11): 725-730.
8.	Ramkumar PN, Chu CT, Harris JD, et al. Causes and rates of unplanned readmissions after elective primary total joint arthroplasty: a systematic review and meta-analysis. Am J Orthop (Belle Mead NJ), 2015, 44(9): 397-405.
9.	Whitehouse JD, Friedman ND, Kirkland KB, et al. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol, 2002, 23(4): 183-189.
10.	Bosco JA 3rd, Karkenny AJ, Hutzler LH, et al. Cost burden of 30-day readmissions following medicare total hip and knee arthroplasty. J Arthroplasty, 2014, 29(5): 903-905.
11.	Jensen JE, Jensen TG, Smith TK, et al. Nutrition in orthopaedic surgery. J Bone Joint Surg Am, 1982, 64(9): 1263-1272.
12.	Smith TK. Prevention of complications in orthopedic surgery secondary to nutritional depletion. Clin Orthop Relat Res, 1987(222): 91-97.
13.	Greene KA, Wilde AH, Stulberg BN. Preoperative nutritional status of total joint patients. Relationship to postoperative wound complications. J Arthroplasty, 1991, 6(4): 321-325.
14.	Dickhaut SC, DeLee JC, Page CP. Nutritional status: importance in predicting wound-healing after amputation. J Bone Joint Surg Am, 1984, 66(1): 71-75.
15.	Eneroth M, Apelqvist J, Larsson J, et al. Improved wound healing in transtibial amputees receiving supplementary nutrition. Int Orthop, 1997, 21(2): 104-108.
16.	Jaberi FM, Parvizi J, Haytmanek CT, et al. Procrastination of wound drainage and malnutrition affect the outcome of joint arthroplasty. Clin Orthop Relat Res, 2008, 466(6): 1368-1371.
17.	Haro-Gómez HL, Merida-Herrera E, Torres-Fernández BJ, et al. Preoperative serum albumin as a predictor of complications following total hip replacement in patients with rheumatoid arthritis. Acta Ortop Mex, 2018, 32(4): 193-197.
18.	Huang R, Greenky M, Kerr GJ, et al. The effect of malnutrition on patients undergoing elective joint arthroplasty. J Arthroplasty, 2013, 28(8 Suppl): 21-24.
19.	Mueller MM, Van Remoortel H, Meybohm P, et al. Patient blood management: recommendations from the 2018 Frankfurt Consensus Conference. JAMA, 2019, 321(10): 983-997.
20.	Murphy GJ, Reeves BC, Rogers CA, et al. Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation, 2007, 116(22): 2544-2552.
21.	Hendrickson JE, Hillyer CD. Noninfectious serious hazards of transfusion. Anesth Analg, 2009, 108(3): 759-769.
22.	Vamvakas EC, Blajchman MA. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood, 2009, 113(15): 3406-3417.
23.	Klasan A, Dworschak P, Heyse TJ, et al. Transfusions increase complications and infections after hip and knee arthroplasty: an analysis of 2760 cases. Technol Health Care, 2018, 26(5): 825-832.
24.	Frisch NB, Wessell NM, Charters MA, et al. Predictors and complications of blood transfusion in total hip and knee arthroplasty. J Arthroplasty, 2014, 29(9 Suppl): 189-192.
25.	Yoshihara H, Yoneoka D. Predictors of allogeneic blood transfusion in total hip and knee arthroplasty in the United States, 2000-2009. J Arthroplasty, 2014, 29(9): 1736-1740.
26.	Kim JL, Park JH, Han SB, et al. Allogeneic blood transfusion is a significant risk factor for surgical-site infection following total hip and knee arthroplasty: a meta-analysis. J Arthroplasty, 2017, 32(1): 320-325.
27.	Almustafa MA, Ewen AM, Deakin AH, et al. Risk factors for surgical site infection following lower limb arthroplasty: a retrospective cohort analysis of 3932 lower limb arthroplasty procedures in a high volume arthroplasty unit. J Arthroplasty, 2018, 33(6): 1861-1867.
28.	Rhee C, Lethbridge L, Richardson G, et al. Risk factors for infection, revision, death, blood transfusion and longer hospital stay 3 months and 1 year after primary total hip or knee arthroplasty. Can J Surg, 2018, 61(3): 165-176.
29.	O'Toole P, Maltenfort MG, Chen AF, et al. Projected increase in periprosthetic joint infections secondary to rise in diabetes and obesity. J Arthroplasty, 2016, 31(1): 7-10.
30.	Zhu Y, Zhang F, Chen W, et al. Risk factors for periprosthetic joint infection after total joint arthroplasty: a systematic review and meta-analysis. J Hosp Infect, 2015, 89(2): 82-89.
31.	Jones RE, Russell RD, Huo MH. Wound healing in total joint replacement. Bone Joint J, 2013, 95-B(11 Suppl A): 144-147.
32.	Jämsen E, Nevalainen P, Eskelinen A, et al. Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: a single-center analysis of 7181 primary hip and knee replacements for osteoarthritis. J Bone Joint Surg Am, 2012, 94(14): e101.
33.	Hwang JS, Kim SJ, Bamne AB, et al. Do glycemic markers predict occurrence of complications after total knee arthroplasty in patients with diabetes?. Clin Orthop Relat Res, 2015, 473(5): 1726-1731.
34.	张宏, 于德民, 陈樱, 等. 2型糖尿病患者免疫功能变化与血糖和胰岛素水平相关性的研究. 标记免疫分析与临床, 2002, 9(2): 90-94.
35.	Jahng KH, Bas MA, Rodriguez JA, et al. Risk factors for wound complications after direct anterior approach hip arthroplasty. J Arthroplasty, 2016, 31(11): 2583-2587.
36.	Wallace G, Judge A, Prieto-Alhambra D, et al. The effect of body mass index on the risk of post-operative complications during the 6 months following total hip replacement or total knee replacement surgery. Osteoarthritis Cartilage, 2014, 22(7): 918-927.
37.	Singh JA, Schleck C, Harmsen WS, et al. Current tobacco use is associated with higher rates of implant revision and deep infection after total hip or knee arthroplasty: a prospective cohort study. BMC Med, 2015, 13: 283.
38.	Duchman KR, Gao Y, Pugely AJ, et al. The effect of smoking on short-term complications following total hip and knee arthroplasty. J Bone Joint Surg Am, 2015, 97(13): 1049-1058.
39.	Sutphen SA, Berend KR, Morris MJ, et al. Direct anterior approach has lower deep infection frequency than less invasive direct lateral approach in primary total hip arthroplasty. J Surg Orthop Adv, 2018, 27(1): 21-24.
40.	Duchman KR, Pugely AJ, Martin CT, et al. Operative time affects short-term complications in total joint arthroplasty. J Arthroplasty, 2017, 32(4): 1285-1291.
41.	Bohl DD, Ondeck NT, Darrith B, et al. Impact of operative time on adverse events following primary total joint arthroplasty. J Arthroplasty, 2018, 33(7): 2256-2262.
42.	Bloch BV, Shah A, Snape SE, et al. Primary hip and knee arthroplasty in a temporary operating theatre is associated with a significant increase in deep periprosthetic infection. Bone Joint J, 2017, 99-B(7): 917-920.

1. Kurtz S, Ong K, Lau E, et al. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am, 2007, 89(4): 780-785.
2. Derman PB, Fabricant PD, David G. The role of overweight and obesity in relation to the more rapid growth of total knee arthroplasty volume compared with total hip arthroplasty volume. J Bone Joint Surg Am, 2014, 96(11): 922-928.
3. Sueyoshi T, Meding JB, Davis KE, et al. Clinical predictors for possible failure after total hip arthroplasty. Hip Int, 2016, 26(6): 531-536.
4. Pugely AJ, Martin CT, Gao Y, et al. The incidence of and risk factors for 30-day surgical site infections following primary and revision total joint arthroplasty. J Arthroplasty, 2015, 30(9 Suppl): 47-50.
5. Public Health England. Surveillance of surgical site infections in NHS hospitals in England, 2017 to 2018. (2018-12-17)[2019-06-01]. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/765967/SSI_annual_report_NHS_hospitals_2017_18.pdf.
6. 谢章家, 庞安琪, 谢壮. 人工全髋关节置换术后早期手术部位感染的危险因素分析. 中华关节外科杂志(电子版), 2011, 5(4): 446-450.
7. Kirkland KB, Briggs JP, Trivette SL, et al. The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs. Infect Control Hosp Epidemiol, 1999, 20(11): 725-730.
8. Ramkumar PN, Chu CT, Harris JD, et al. Causes and rates of unplanned readmissions after elective primary total joint arthroplasty: a systematic review and meta-analysis. Am J Orthop (Belle Mead NJ), 2015, 44(9): 397-405.
9. Whitehouse JD, Friedman ND, Kirkland KB, et al. The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay, and extra cost. Infect Control Hosp Epidemiol, 2002, 23(4): 183-189.
10. Bosco JA 3rd, Karkenny AJ, Hutzler LH, et al. Cost burden of 30-day readmissions following medicare total hip and knee arthroplasty. J Arthroplasty, 2014, 29(5): 903-905.
11. Jensen JE, Jensen TG, Smith TK, et al. Nutrition in orthopaedic surgery. J Bone Joint Surg Am, 1982, 64(9): 1263-1272.
12. Smith TK. Prevention of complications in orthopedic surgery secondary to nutritional depletion. Clin Orthop Relat Res, 1987(222): 91-97.
13. Greene KA, Wilde AH, Stulberg BN. Preoperative nutritional status of total joint patients. Relationship to postoperative wound complications. J Arthroplasty, 1991, 6(4): 321-325.
14. Dickhaut SC, DeLee JC, Page CP. Nutritional status: importance in predicting wound-healing after amputation. J Bone Joint Surg Am, 1984, 66(1): 71-75.
15. Eneroth M, Apelqvist J, Larsson J, et al. Improved wound healing in transtibial amputees receiving supplementary nutrition. Int Orthop, 1997, 21(2): 104-108.
16. Jaberi FM, Parvizi J, Haytmanek CT, et al. Procrastination of wound drainage and malnutrition affect the outcome of joint arthroplasty. Clin Orthop Relat Res, 2008, 466(6): 1368-1371.
17. Haro-Gómez HL, Merida-Herrera E, Torres-Fernández BJ, et al. Preoperative serum albumin as a predictor of complications following total hip replacement in patients with rheumatoid arthritis. Acta Ortop Mex, 2018, 32(4): 193-197.
18. Huang R, Greenky M, Kerr GJ, et al. The effect of malnutrition on patients undergoing elective joint arthroplasty. J Arthroplasty, 2013, 28(8 Suppl): 21-24.
19. Mueller MM, Van Remoortel H, Meybohm P, et al. Patient blood management: recommendations from the 2018 Frankfurt Consensus Conference. JAMA, 2019, 321(10): 983-997.
20. Murphy GJ, Reeves BC, Rogers CA, et al. Increased mortality, postoperative morbidity, and cost after red blood cell transfusion in patients having cardiac surgery. Circulation, 2007, 116(22): 2544-2552.
21. Hendrickson JE, Hillyer CD. Noninfectious serious hazards of transfusion. Anesth Analg, 2009, 108(3): 759-769.
22. Vamvakas EC, Blajchman MA. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood, 2009, 113(15): 3406-3417.
23. Klasan A, Dworschak P, Heyse TJ, et al. Transfusions increase complications and infections after hip and knee arthroplasty: an analysis of 2760 cases. Technol Health Care, 2018, 26(5): 825-832.
24. Frisch NB, Wessell NM, Charters MA, et al. Predictors and complications of blood transfusion in total hip and knee arthroplasty. J Arthroplasty, 2014, 29(9 Suppl): 189-192.
25. Yoshihara H, Yoneoka D. Predictors of allogeneic blood transfusion in total hip and knee arthroplasty in the United States, 2000-2009. J Arthroplasty, 2014, 29(9): 1736-1740.
26. Kim JL, Park JH, Han SB, et al. Allogeneic blood transfusion is a significant risk factor for surgical-site infection following total hip and knee arthroplasty: a meta-analysis. J Arthroplasty, 2017, 32(1): 320-325.
27. Almustafa MA, Ewen AM, Deakin AH, et al. Risk factors for surgical site infection following lower limb arthroplasty: a retrospective cohort analysis of 3932 lower limb arthroplasty procedures in a high volume arthroplasty unit. J Arthroplasty, 2018, 33(6): 1861-1867.
28. Rhee C, Lethbridge L, Richardson G, et al. Risk factors for infection, revision, death, blood transfusion and longer hospital stay 3 months and 1 year after primary total hip or knee arthroplasty. Can J Surg, 2018, 61(3): 165-176.
29. O'Toole P, Maltenfort MG, Chen AF, et al. Projected increase in periprosthetic joint infections secondary to rise in diabetes and obesity. J Arthroplasty, 2016, 31(1): 7-10.
30. Zhu Y, Zhang F, Chen W, et al. Risk factors for periprosthetic joint infection after total joint arthroplasty: a systematic review and meta-analysis. J Hosp Infect, 2015, 89(2): 82-89.
31. Jones RE, Russell RD, Huo MH. Wound healing in total joint replacement. Bone Joint J, 2013, 95-B(11 Suppl A): 144-147.
32. Jämsen E, Nevalainen P, Eskelinen A, et al. Obesity, diabetes, and preoperative hyperglycemia as predictors of periprosthetic joint infection: a single-center analysis of 7181 primary hip and knee replacements for osteoarthritis. J Bone Joint Surg Am, 2012, 94(14): e101.
33. Hwang JS, Kim SJ, Bamne AB, et al. Do glycemic markers predict occurrence of complications after total knee arthroplasty in patients with diabetes?. Clin Orthop Relat Res, 2015, 473(5): 1726-1731.
34. 张宏, 于德民, 陈樱, 等. 2型糖尿病患者免疫功能变化与血糖和胰岛素水平相关性的研究. 标记免疫分析与临床, 2002, 9(2): 90-94.
35. Jahng KH, Bas MA, Rodriguez JA, et al. Risk factors for wound complications after direct anterior approach hip arthroplasty. J Arthroplasty, 2016, 31(11): 2583-2587.
36. Wallace G, Judge A, Prieto-Alhambra D, et al. The effect of body mass index on the risk of post-operative complications during the 6 months following total hip replacement or total knee replacement surgery. Osteoarthritis Cartilage, 2014, 22(7): 918-927.
37. Singh JA, Schleck C, Harmsen WS, et al. Current tobacco use is associated with higher rates of implant revision and deep infection after total hip or knee arthroplasty: a prospective cohort study. BMC Med, 2015, 13: 283.
38. Duchman KR, Gao Y, Pugely AJ, et al. The effect of smoking on short-term complications following total hip and knee arthroplasty. J Bone Joint Surg Am, 2015, 97(13): 1049-1058.
39. Sutphen SA, Berend KR, Morris MJ, et al. Direct anterior approach has lower deep infection frequency than less invasive direct lateral approach in primary total hip arthroplasty. J Surg Orthop Adv, 2018, 27(1): 21-24.
40. Duchman KR, Pugely AJ, Martin CT, et al. Operative time affects short-term complications in total joint arthroplasty. J Arthroplasty, 2017, 32(4): 1285-1291.
41. Bohl DD, Ondeck NT, Darrith B, et al. Impact of operative time on adverse events following primary total joint arthroplasty. J Arthroplasty, 2018, 33(7): 2256-2262.
42. Bloch BV, Shah A, Snape SE, et al. Primary hip and knee arthroplasty in a temporary operating theatre is associated with a significant increase in deep periprosthetic infection. Bone Joint J, 2017, 99-B(7): 917-920.

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