{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T23:01:55Z","timestamp":1784847715029,"version":"3.55.0"},"reference-count":33,"publisher":"Georg Thieme Verlag KG","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Superficial surgical site infections (SSIs) limited to the skin and subcutaneous tissue following total joint arthroplasty (TJA) remain a significant source of patient morbidity, often necessitating surgical irrigation and debridement (I&amp;D). While risk factors for deep infections such as periprosthetic joint infections are well studied, predictors of superficial SSIs managed with I&amp;D remain underexplored. A retrospective cohort analysis was performed using the PearlDiver Mariner10 capturing over 161 million patients across inpatient and outpatient settings in the United States. Patients undergoing primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) between 2010 and 2022 were identified and stratified by the occurrence of subsequent wound I&amp;D. Patients who underwent prosthetic revision were excluded to isolate superficial infections. A total of 54,868 THA and 103,235 TKA patients were identified, with 405 (0.738%) and 568 (0.549%) requiring I&amp;D, respectively. Among THA patients, significant predictors of superficial SSI requiring I&amp;D included obesity (odds ratio [OR]: 1.91, p\u2009&lt;\u20090.001), hypothyroidism (OR: 1.45, p\u2009=\u20090.005), anemia (OR: 1.64, p\u2009&lt;\u20090.001), Type II diabetes mellitus (OR: 1.70, p\u2009&lt;\u20090.001), and chronic obstructive pulmonary disease (COPD) (OR: 1.51, p\u2009=\u20090.004). In the TKA cohort, significant predictors included obesity (OR: 1.40, p\u2009=\u20090.002), anemia (OR: 2.21, p\u2009&lt;\u20090.001), malnutrition (OR: 2.18, p\u2009&lt;\u20090.001), Type II diabetes mellitus (OR: 1.43, p\u2009=\u20090.001), tobacco use (OR: 1.45, p\u2009=\u20090.005), and COPD (OR: 2.02, p\u2009&lt;\u20090.001). The findings emphasize the importance of targeted preoperative optimization in patients with risk factors such as obesity, anemia, malnutrition, diabetes, and COPD. Differential predictors between TKA and THA highlight the need for joint-specific perioperative strategies.<\/jats:p>","DOI":"10.1055\/a-2796-8070","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:16:46Z","timestamp":1769645806000},"page":"540-546","source":"Crossref","is-referenced-by-count":0,"title":["Obesity, Anemia, and Chronic Obstructive Pulmonary Disease Identified as Key Risk Factors of Superficial Wound Washouts After Total Joint Arthroplasty"],"prefix":"10.1055","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0614-0941","authenticated-orcid":false,"given":"Nicholas","family":"Stratigakis","sequence":"additional","affiliation":[{"name":"State University of New York (SUNY) Downstate Health Sciences University College of Medicine, Brooklyn, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar","family":"Champigneulle","sequence":"additional","affiliation":[{"name":"State University of New York (SUNY) Downstate Health Sciences University College of Medicine, Brooklyn, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Baum","sequence":"additional","affiliation":[{"name":"State University of New York (SUNY) Downstate Health Sciences University College of Medicine, Brooklyn, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quais","family":"Naziri","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, State University of New York (SUNY) Downstate, Brooklyn, New York, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"issue":"01","key":"ref1","first-page":"e22","article-title":"Projections and epidemiology of primary hip and knee arthroplasty in Medicare patients to 2040-2060","volume":"8","author":"I Shichman","year":"2023","journal-title":"JB JS Open Access"},{"issue":"17","key":"ref2","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.2106\/JBJS.17.01617","article-title":"Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030","volume":"100","author":"M Sloan","year":"2018","journal-title":"J Bone Joint Surg Am"},{"issue":"10","key":"ref3","doi-asserted-by":"crossref","first-page":"2099","DOI":"10.1016\/j.arth.2016.03.045","article-title":"Which hospital and clinical factors drive 30- and 90-day readmission after TKA?","volume":"31","author":"S M Kurtz","year":"2016","journal-title":"J Arthroplasty"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"2286","DOI":"10.1111\/iwj.14032","article-title":"A systematic review of cost and well-being in hip and knee replacements surgical site infections","volume":"20","author":"Y GV Hon","year":"2023","journal-title":"Int Wound J"},{"issue":"07","key":"ref5","doi-asserted-by":"crossref","first-page":"1452","DOI":"10.1016\/j.arth.2019.03.032","article-title":"Outcomes of superficial and deep irrigation and debridement in total hip and knee arthroplasty","volume":"34","author":"J Manrique","year":"2019","journal-title":"J Arthroplasty"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"20","DOI":"10.7150\/jbji.14075","article-title":"The effectiveness of debridement, antibiotics and irrigation for periprosthetic joint infections after primary hip and knee arthroplasty. A 15 years retrospective study in two community hospitals in the Netherlands","volume":"1","author":"L de Vries","year":"2016","journal-title":"J Bone Jt Infect"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.arth.2013.09.043","article-title":"Irrigation and debridement","volume":"29","author":"C Haasper","year":"2014","journal-title":"J Arthroplasty"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1128\/CMR.00111-13","article-title":"Prosthetic joint infection","volume":"27","author":"A J Tande","year":"2014","journal-title":"Clin Microbiol Rev"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s00402-019-03304-6","article-title":"Risk factors for periprosthetic joint infection after total knee arthroplasty","volume":"140","author":"J F Blanco","year":"2020","journal-title":"Arch Orthop Trauma Surg"},{"issue":"09","key":"ref10","doi-asserted-by":"crossref","first-page":"794","DOI":"10.2106\/JBJS.K.00072","article-title":"Patient-related risk factors for periprosthetic joint infection and postoperative mortality following total hip arthroplasty in Medicare patients","volume":"94","author":"K J Bozic","year":"2012","journal-title":"J Bone Joint Surg Am"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"5","DOI":"10.29245\/2767-5092\/2022\/3.1157","article-title":"Effects of obesity on infections with emphasis on skin infections and wound healing","volume":"4","author":"D Frasca","year":"2022","journal-title":"J Dermatol Skin Sci"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1038\/ijo.2012.62","article-title":"Obesity and the risk and outcome of infection","volume":"37","author":"R Huttunen","year":"2013","journal-title":"Int J Obes"},{"issue":"02","key":"ref13","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1111\/1469-0691.12209","article-title":"Risk factors for superficial wound complications in hip and knee arthroplasty","volume":"20","author":"K Carroll","year":"2014","journal-title":"Clin Microbiol Infect"},{"issue":"09","key":"ref14","doi-asserted-by":"crossref","first-page":"e060754","DOI":"10.1136\/bmjopen-2022-060754","article-title":"Patient-related factors associated with superficial surgical site infection and progression to a periprosthetic joint infection after elective primary total joint arthroplasty: a single-centre, retrospective study in Sweden","volume":"12","author":"H K Eriksson","year":"2022","journal-title":"BMJ Open"},{"issue":"06","key":"ref15","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1055\/s-0041-1741396","article-title":"The use of artificial neural networks for the prediction of surgical site infection following TKA","volume":"36","author":"I Yeo","year":"2023","journal-title":"J Knee Surg"},{"issue":"01","key":"ref16","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.joca.2019.10.005","article-title":"Greater risks of complications, infections, and revisions in the obese versus non-obese total hip arthroplasty population of 2,190,824 patients: a meta-analysis and systematic review","volume":"28","author":"J R Onggo","year":"2020","journal-title":"Osteoarthritis Cartilage"},{"issue":"02","key":"ref17","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1152\/physrev.00030.2013","article-title":"Thyroid hormone regulation of metabolism","volume":"94","author":"R Mullur","year":"2014","journal-title":"Physiol Rev"},{"issue":"04","key":"ref18","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1016\/j.arth.2015.10.028","article-title":"Increased risk of periprosthetic joint infections in patients with hypothyroidism undergoing total joint arthroplasty","volume":"31","author":"T L Tan","year":"2016","journal-title":"J Arthroplasty"},{"issue":"04","key":"ref19","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1016\/j.arth.2017.10.053","article-title":"Hypothyroidism increases 90-day complications and costs following primary total knee arthroplasty","volume":"33","author":"L T Buller","year":"2018","journal-title":"J Arthroplasty"},{"issue":"09","key":"ref20","doi-asserted-by":"crossref","first-page":"2971","DOI":"10.1016\/j.arth.2018.04.027","article-title":"Malnutrition and the development of periprosthetic joint infection in patients undergoing primary elective total joint arthroplasty","volume":"33","author":"K Blevins","year":"2018","journal-title":"J Arthroplasty"},{"issue":"01","key":"ref21","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.jhin.2019.04.020","article-title":"Association of malnutrition with periprosthetic joint and surgical site infections after total joint arthroplasty: a systematic review and meta-analysis","volume":"103","author":"A G Tsantes","year":"2019","journal-title":"J Hosp Infect"},{"issue":"293","key":"ref22","first-page":"188","article-title":"Delayed wound healing and nutritional deficiencies after total hip arthroplasty","author":"S Gherini","year":"1993","journal-title":"Clin Orthop Relat Res"},{"issue":"04","key":"ref23","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/S0883-5403(06)80183-X","article-title":"Preoperative nutritional status of total joint patients. Relationship to postoperative wound complications","volume":"6","author":"K A Greene","year":"1991","journal-title":"J Arthroplasty"},{"issue":"03","key":"ref24","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1177\/0022034509359125","article-title":"Factors affecting wound healing","volume":"89","author":"S Guo","year":"2010","journal-title":"J Dent Res"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"S169","DOI":"10.1016\/j.arth.2025.02.058","article-title":"Preoperative anemia as a predictor of periprosthetic joint infection following total knee arthroplasty: a continuous variable analysis","volume":"40","author":"S S Telang","year":"2025","journal-title":"J Arthroplasty"},{"issue":"04","key":"ref26","doi-asserted-by":"crossref","first-page":"288","DOI":"10.2106\/JBJS.17.00237","article-title":"Perioperative allogeneic red blood-cell transfusion associated with surgical site infection after total hip and knee arthroplasty","volume":"100","author":"J S Everhart","year":"2018","journal-title":"J Bone Joint Surg Am"},{"issue":"02","key":"ref27","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1177\/193229681100500231","article-title":"Perioperative hyperglycemia and postoperative infection after lower limb arthroplasty","volume":"5","author":"B Mraovic","year":"2011","journal-title":"J Diabetes Sci Technol"},{"issue":"07","key":"ref28","doi-asserted-by":"crossref","first-page":"2312","DOI":"10.1016\/j.arth.2018.02.020","article-title":"Inadequate glycemic control is associated with increased surgical site infection in total joint arthroplasty: a systematic review and meta-analysis","volume":"33","author":"N Shohat","year":"2018","journal-title":"J Arthroplasty"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"S169","DOI":"10.1513\/AnnalsATS.201503-126AW","article-title":"Immune dysfunction in patients with chronic obstructive pulmonary disease","volume":"12","author":"T A Bhat","year":"2015","journal-title":"Ann Am Thorac Soc"},{"issue":"12","key":"ref30","doi-asserted-by":"crossref","first-page":"825","DOI":"10.7326\/M18-2217","article-title":"Risk of biologics and glucocorticoids in patients with rheumatoid arthritis undergoing arthroplasty: a cohort study","volume":"170","author":"M D George","year":"2019","journal-title":"Ann Intern Med"},{"issue":"04","key":"ref31","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1302\/0301-620X.87B4.15546","article-title":"Infection in hip arthroplasty after previous injection of steroid","volume":"87","author":"S Kaspar","year":"2005","journal-title":"J Bone Joint Surg Br"},{"issue":"04","key":"ref32","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1046\/j.1365-2613.2000.00162.x","article-title":"Cigarette smoking, endothelial injury and cardiovascular disease","volume":"81","author":"R Michael Pittilo","year":"2000","journal-title":"Int J Exp Pathol"},{"issue":"06","key":"ref33","first-page":"E374","article-title":"Decreasing the incidence of surgical-site infections after total joint arthroplasty","volume":"46","author":"J B Mistry","year":"2017","journal-title":"Am J Orthop"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2796-8070.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T22:32:24Z","timestamp":1784845944000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2796-8070"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,28]]},"references-count":33,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,7,23]]},"published-print":{"date-parts":[[2026,8]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2796-8070","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,1,28]]},"published":{"date-parts":[[2026,1,28]]}}}