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Preoperative Optimization to Prevent an Infected Total Knee Arthroplasty: Host Factors

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The Infected Total Knee Arthroplasty

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Abstract

A large number of host risk factors have been identified with an increasing number of papers demonstrating many times higher PJI rates in these patients. Some may be easier and faster to address than others. Patients who present with multiple risk factors need to have a clear understanding of the morbidity involved with PJI, and as clinicians there needs to be a planned approach in how to identify which of these conditions can be optimized and an appropriate time frame set to achieve this.

With a rise in obesity and diabetes, we may start to see an associated increase in PJI. Without good evidence to support bariatric surgery and many patients struggling with weight loss, it may be that the additional risk needs to be accepted. Identification of an early arthritic group who could be targeted for weight loss would seem logical.

When presented with an obese, diabetic patient with multiple other risk factors, there may be a point when optimization has been achieved, but the considerable increased risk of PJI remains. Further research will need to better quantify this risk in order to educate and consent patients, better prepare health services for the likelihood of complications arising, and ensure registry data is appropriately adjusted for risk.

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Authors and Affiliations

  1. Specialist Registrar, University College London Hospital, London, UK

    Sven E. Putnis FRCS (T&O)

  2. Department of Orthopaedic Surgery, University College Hospital, 235 Euston Road, London, NW1 2BU, UK

    Sam Oussedik

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  1. Sven E. Putnis FRCS (T&O)
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  1. Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain

    E. Carlos Rodríguez-Merchán

  2. University College London Hospitals , London, United Kingdom

    Sam Oussedik

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Putnis, S.E., Oussedik, S. (2018). Preoperative Optimization to Prevent an Infected Total Knee Arthroplasty: Host Factors. In: Rodríguez-Merchán, E., Oussedik, S. (eds) The Infected Total Knee Arthroplasty. Springer, Cham. https://doi.org/10.1007/978-3-319-66730-0_3

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