Risk factors for periprosthetic joint infection after total knee arthroplasty

  • Juan F. BlancoEmail author
  • Agustín Díaz
  • Francisco R. Melchor
  • Carmen da Casa
  • David Pescador
Knee Arthroplasty



Periprosthetic joint infection (PJI) is the most serious and feared complication in total knee arthroplasty (TKA) and can have catastrophic consequences. The number of total knee arthroplasties is increasing, so infections could also be greater in the future. The aim of this study is to identify the most relevant risk factors associated with infection after a total knee arthroplasty.


This is a case–control study of patients who underwent total knee arthroplasty at the University Hospital of Salamanca. We included 66 TKA PJI patients and 66 control TKA patients. Demographic and clinical variables were collected. A descriptive and inferential analysis was performed by logistic regression and attributable risk fraction assessed.


Prolonged operative time (> 90′) and tourniquet time (> 60′) were the most relevant risk factors described (OR 40.77, AFE 0.97, p > 0.001 and OR 37.14, AFE 0.97, p < 0.001, respectively). The use of non-antibiotic-laded cement (OR 3.62), obesity (BMI > 30, OR 8.86), diabetes (OR 2.33), high ASA grade (III–IV, OR 15.30), and blood transfusion requirement (OR 4.60) were also statistically significant risk factors for TKA PJI.


Our study provides evidence concerning that operative time, tourniquet time, cement type, diabetes, obesity, ASA grade, and blood transfusion requirement as independently associated risk factors for TKA PJI. Modifiable risk factors were specifically relevant, so we should be able to reduce the infection rate.


Periprosthetic joint infection Total knee arthroplasty Risk factor 



Body mass index


Erythrocyte sedimentation rate


Periprosthetic joint infection




C-reactive protein


Total knee arthroplasty


University Hospital of Salamanca



Authors would like to specially thank Dr. Agustín Soler (Department of Orthopedic Surgery, Lister Hospital, United Kingdom) for English language support.

Compliance with ethical standards

Conflict of interest

Juan F Blanco, Agustin Díaz, Francisco R Melchor, Carmen da Casa and David Pescador declare that they have no conflict of interest.

Availability of data

All data are available from the corresponding author upon reasonable request.

Ethical approval

All procedures were in accordance with the ethical standards of the University Hospital of Salamanca Clinical Research Committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Trauma and Orthopedic SurgeryUniversity Hospital of SalamancaSalamancaSpain
  2. 2.Instituto de Investigación Biomédica de Salamanca (IBSAL)SalamancaSpain
  3. 3.Department of AnesthesiaUniversity Hospital of SalamancaSalamancaSpain

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