University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Orthopaedic Surgery


Elyse Watkins DHSc, PA-C, DFAAPA



Background: Despite the overall success of total hip and total knee arthroplasty, prosthetic joint infection (PJI) remains a significant and impactful complication. The long-term cost to patients and the healthcare system is significant and there are many surgical measures that focus on the treatment of PJI. Optimizing methods of prevention of PJIs can make a huge impact on outcomes for patients. While there are many methods of prevention, this paper will focus on preoperative and perioperative factors which play a major role in minimizing the risk of incurring a prosthetic joint infection.

Purpose: The purpose of this article is to review current literature regarding preoperative and perioperative prevention of infection in primary total knee and total hip arthroplasty.

Method: An extensive search of literature from PubMed was completed using the terms periprosthetic, prosthetic joint infection, total knee infection, total hip infection, prevention of prosthetic joint infection, and prevention of joint infection. A total of 26 articles were obtained and used for the purpose of this clinical review.

Exclusion criteria: Studies that focused on revision surgery, non-joint replacement surgery, patients with a history of prior prosthetic joint infection, and postoperative methods of prevention were excluded for the purposes of this article.

Results: There are numerous methods associated with decreasing incidence of prosthetic joint infection after total hip and knee replacement surgery. Mitigating risk factors and maintaining sterile operating room environment with appropriate antibiotic coverage remains the best method of prevention of prosthetic joint infection.

Conclusion: Prosthetic joint infection is one of the most detrimental complications for a patient with a hip or knee replacement. There have been many advances over the years in surgical technique, prosthetic composition and fixation, and antibiotic and biofilm suppression. Despite encouraging evidence supporting certain preventative measures for prosthetic joint infections, ongoing research must be completed to ensure the best preventative measures are always used.

Keywords: Prosthetic joint infection, periprosthetic joint infection, total knee, total hip, infection, prevention


Available when accessing via a campus IP address or logged in with a University of Lynchburg email address.

Off-campus users can also use 'Off-campus Download' button above for access.