{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T16:53:27Z","timestamp":1775494407498,"version":"3.50.1"},"reference-count":50,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,11,9]],"date-time":"2018-11-09T00:00:00Z","timestamp":1541721600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2018,11,9]],"date-time":"2018-11-09T00:00:00Z","timestamp":1541721600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2018,11,9]],"date-time":"2018-11-09T00:00:00Z","timestamp":1541721600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Knee surg. sports traumatol. arthrosc."],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>The goal of this systematic review and meta\u2010analysis was to identify the main risk factors for periprosthetic joint infection (PJI) in patients undergoing total hip or knee arthroplasties.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic review was conducted of the potential risk factors for PJI in total hip or total knee arthroplasty. Risk factors were compared and grouped according to demographics, comorbidities, behavior, infections, native joint diseases and other patient\u2010related and procedure\u2010related factors. Meta\u2010analysis (random\u2010effects models) was conducted using odds ratio (OR) and mean difference (MD). Risk of bias (ROBBINS\u2010I) and strength of the evidence (GRADE) were assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study included 37 studies (2,470,827 patients). Older age was a protective factor (MD = \u2212 1.18). Male gender (OR 1.34), coagulopathy (3.05), congestive heart failure (2.36), diabetes mellitus (1.80), obesity (1.61), systemic neoplasia (1.57), chronic lung disease (1.52), and hypertension (1.21) increased the risk for PJI. Behavioral risk factors comprised alcohol abuse (2.95), immunosuppressive therapy (2.81), steroid therapies (1.88), and tobacco (1.82). Infectious risk factors included surgical site infections (6.14), postoperative urinary tract infections (2.85), and prior joint infections (2.15). Rheumatoid arthritis, posttraumatic native joint disease, high National Nosocomial Infections Surveillance (NNIS) system surgical patient index score, prior joint operation, American Society of Anesthesiologists score\u2009\u2265\u20093 and obesity were also significantly associated with higher risk of PJI. Osteoarthritis and blood transfusion were protective factors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The main risk factors for PJI in each category were male gender, coagulopathy, alcohol abuse, surgical site infection (highest score) and high NNIS system surgical patient index score. Protective factors were age, female gender in TKA, osteoarthritis and blood transfusion. Optimization of modifiable risk factors for PJI should be attempted in clinical practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of evidence<\/jats:title><jats:p>II.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00167-018-5231-9","type":"journal-article","created":{"date-parts":[[2018,11,9]],"date-time":"2018-11-09T04:02:54Z","timestamp":1541736174000},"page":"8-43","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":77,"title":["Higher age, female gender, osteoarthritis and blood transfusion protect against periprosthetic joint infection in total hip or knee arthroplasties: a systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4761-9970","authenticated-orcid":false,"given":"Vera Alice Correia","family":"Resende","sequence":"first","affiliation":[{"name":"<!--<label>1<\/label>--> Escola Nacional de Sa\u00fade P\u00fablica Universidade NOVA de Lisboa Lisbon Portugal"},{"name":"<!--<label>2<\/label>--> Centro Hospitalar de Entre o Douro e Vouga Rua Dr. C\u00e2ndido de Pinho 4520\u2010211 Santa Maria da Feira Portugal"}]},{"given":"Artur Costa","family":"Neto","sequence":"additional","affiliation":[{"name":"<!--<label>2<\/label>--> Centro Hospitalar de Entre o Douro e Vouga Rua Dr. C\u00e2ndido de Pinho 4520\u2010211 Santa Maria da Feira Portugal"}]},{"given":"Carla","family":"Nunes","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Escola Nacional de Sa\u00fade P\u00fablica Universidade NOVA de Lisboa Lisbon Portugal"},{"name":"<!--<label>3<\/label>--> Centro de Investiga\u00e7\u00e3o em Sa\u00fade P\u00fablica, Escola Nacional de Sa\u00fade P\u00fablica Universidade NOVA de Lisboa Lisbon Portugal"}]},{"given":"Renato","family":"Andrade","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Cl\u00ednica do Drag\u00e3o Espregueira\u2010Mendes Sports Centre\u2010FIFA Medical Centre of Excellence Porto Portugal"},{"name":"<!--<label>5<\/label>--> Faculty of Sports University of Porto Porto Portugal"},{"name":"<!--<label>6<\/label>--> Dom Henrique Research Centre Porto Portugal"}]},{"given":"Jo\u00e3o","family":"Espregueira\u2010Mendes","sequence":"additional","affiliation":[{"name":"<!--<label>4<\/label>--> Cl\u00ednica do Drag\u00e3o Espregueira\u2010Mendes Sports Centre\u2010FIFA Medical Centre of Excellence Porto Portugal"},{"name":"<!--<label>6<\/label>--> Dom Henrique Research Centre Porto Portugal"},{"name":"<!--<label>7<\/label>--> 3B\u2019s Research Group\u2010Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine AvePark, Parque de Ci\u00eancia e Tecnologia, Zona Industrial da Gandra, Barco 4805\u2010017 Guimar\u00e3es Portugal"},{"name":"<!--<label>8<\/label>--> ICVS\/3B\u2019s\u2010PT Government Associate Laboratory Braga\/Guimar\u00e3es Portugal"},{"name":"<!--<label>9<\/label>--> Orthopaedics Department of Minho University Braga Portugal"}]},{"given":"S\u00edlvia","family":"Lopes","sequence":"additional","affiliation":[{"name":"<!--<label>1<\/label>--> Escola Nacional de Sa\u00fade P\u00fablica Universidade NOVA de Lisboa Lisbon Portugal"},{"name":"<!--<label>3<\/label>--> Centro de Investiga\u00e7\u00e3o em Sa\u00fade P\u00fablica, Escola Nacional de Sa\u00fade P\u00fablica Universidade NOVA de Lisboa Lisbon 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