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The European Knee Associates (EKA), the American Association of Hip and Knee Surgeons (AAHKS) International Committee, and the Arthroplasty Society in Asia (ASIA) board members were interested in quantifying differences in arthroplasty surgeons\u2019 use of various PJI prevention measures to provide clinical recommendations to reduce PJI incidence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A prospective Microsoft Forms online survey was distributed among EKA, AAHKS International Committee, and ASIA members and their affiliated arthroplasty surgeons. The survey consisted of 20 single and multiple response questions focused on PJI prevention strategies at three perioperative periods: preoperatively, intraoperatively, and postoperatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Three hundred and ninety\u2010four arthroplasty surgeons from 6 different continents completed the survey. <jats:italic>Preoperative<\/jats:italic>: (A) PJI Risk Stratification: 40.6% routinely set thresholds (e.g., BMI, HgbA1C) to be met to qualify for surgery, 36.5% only review past medical history; 9.1% use machine learning to personalize PJI risk; (B) BMI limit: 36% no limit; 15.4% BMI\u2009&lt;\u200935; 30.9% BMI\u2009&lt;\u200940; 17.2% BMI\u2009&lt;\u200945; (C) Nutritional status: 55.3% do not screen; among those who screen their patients (44.7%), albumin is the single most used marker (86.3%); (D) Hyperglycemia\/Diabetes: 83.3% check this comorbidity; 88.1% use HgbA1C as single best screening test; (E) MRSA nasal colonization: 63.7% do not test; 28.9% test all patients; 7.4% test selectively. <jats:italic>Intraoperative<\/jats:italic>: (A) Antibiotic prophylaxis in high\u2010risk patients: 43.4% use single antibiotic for 24 h; 21.3% use double antibiotic for 24 h; 14.2% use single\/double antibiotic for 7\u00a0days postoperatively; (B) Skin\u2010cleansing: 68.7% at home (45.6% chlorhexidine sponge; 11.9% clippers); (C) Intraoperative skin disinfection: 46.9% single chlorhexidine; 25% double chlorhexidine\u2013povidone\u2010iodine;15.4% single povidone\u2010iodine; (D) Tranexamic acid (TXA) to reduce bleeding\/SSI: 96% yes (51% double IV dose, 35.2% single IV dose, 23.6% intra\u2010articular injection); (E) Surgical suction drain: 52% do not use drains; 19.7% use a drain\u2009&lt;\u200924 h; (F) Intra\u2010articular lavage: 64.9% use only saline; 28.1% use dilute povidone\u2010iodine; (G) Antibiotic local delivery to prevent PJI: 82.4% use antibiotic\u2010added cement. <jats:italic>Postoperative<\/jats:italic>: (A) Routine monitoring of PJI serologic markers: 42% only in symptomatic patients; 34.2% do not; 20.8% in all patients; (B) Serologic markers to rule in\/out PJI: 95.9% CRP; 71% SEDRATE; 60.6% WBC; (C) Synovial fluid test to rule in\/out PJI: 79.6% culture\/sensitivity; 69.5% WBC count; 31.4% CRP.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This survey demonstrated that notable differences still exist in the application of PJI preventive measures across different geographic areas: Optimizing the patient preoperatively and applying multimodal intraoperative strategies represent newer, clinically relevant steps in the effort to reduce the burden of PJI. More uniform guidelines still need to be produced from international scientific societies in order facilitate a more comprehensive approach to this devastating complication.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>IV.<\/jats:p><\/jats:sec><jats:sec><jats:title>Graphical abstract<\/jats:title><jats:p><jats:boxed-text content-type=\"graphic\" position=\"anchor\"><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/ksabf08041-gra-0001-m.png\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:boxed-text><\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-021-06742-1","type":"journal-article","created":{"date-parts":[[2021,9,13]],"date-time":"2021-09-13T13:02:51Z","timestamp":1631538171000},"page":"3932-3943","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["\u201cRecommendations for periprosthetic joint infections (PJI) prevention: the European Knee Associates (EKA)\u2013International Committee American Association of Hip and Knee Surgeons (AAHKS)\u2013Arthroplasty Society in Asia (ASIA) survey of members\u201d"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4752-8027","authenticated-orcid":false,"given":"Pier Francesco","family":"Indelli","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Stanford University School of Medicine PAVAHCS\u2010Surgical Services, 1801 Miranda Ave 94304 Palo Alto CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.","family":"Iannotti","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Sapienza University of Rome Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Ferretti","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Sapienza University of Rome Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Valtanen","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Department of Orthopaedic Surgery Stanford University School of Medicine PAVAHCS\u2010Surgical Services, 1801 Miranda Ave 94304 Palo Alto CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Prati","sequence":"additional","affiliation":[{"name":"<!--<label>3<\/label>--> ASST Bergamo Ovest, Ospedale Treviglio Treviglio Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"P\u00e9rez Prieto","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Department of Orthopaedic Surgery Parc de Salut Mar Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. 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