Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science




Dr. Tom Colletti


Purpose: The purpose of this article is to review and recommend guidelines for preoperative modifiable risk factors prior to total joint replacement (TJR) to reduce the risk and overall incidence of postoperative periprosthetic joint infection (PJI).

Method: A literature search using PubMed and MEDLINE databases was conducted using selected terms and criteria and was limited to articles published within the last ten years.

Results: Research demonstrates the benefit in preoperative weight reduction to a BMI <40, strict blood glucose control in diabetic patients, and >4 weeks of smoking cessation. Avoidance of nephrotoxic medications and creatinine correction in patients with non-dialysis dependent CKD has been shown to improve outcomes if surgery is delayed until corrected. Significant risks in dialysis-dependent patients have been found, however delaying surgery has not been found to improve outcomes or lower complications. Research is inconclusive on addressing inflammatory marker elevation preoperatively. Surgery should be delayed to provide nutritional supplementation in the presence of malnutrition.

Conclusion: Evaluation and management of several modifiable risk factors prior to surgery is shown to be strongly associated with lowering the risk of developing a postoperative periprosthetic joint infection. Addressing obesity, diabetes mellitus, and nutritional status can have substantial effects on lowering PJI incidence and the potential need for revision surgery. Further research is still needed at this time to determine specific recommendations for preoperative risk factor thresholds in order to create a comprehensive guideline for orthopedic surgeons to use preoperatively.


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