{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T20:05:00Z","timestamp":1792872300453,"version":"4.5.0"},"reference-count":77,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,12,11]],"date-time":"2020-12-11T00:00:00Z","timestamp":1607644800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>Background: Periprosthetic joint infection (PJI) represents 25% of failed total knee arthroplasties (TKA). The European Knee Associates (EKA) formed a transatlantic panel of experts to perform a literature review examining patient-related risk factors with the objective of producing perioperative recommendations in PJI high-risk patients. Methods: Multiple databases (Pubmed\/MEDLINE, EMBASE, Scopus, Cochrane Library) and recommendations on TKA PJI prevention measures from the International Consensus Meetings on PJI from the AAOS and AAHKS were reviewed. This represents a Level IV study. Results: Strong evidence was found on poor glycemic control, obesity, malnutrition, and smoking being all associated with increased rates of PJI. In the preoperative period, patient optimization is key: BMI &lt; 35, diet optimization, Hemoglobin A1c &lt; 7.5, Fructosamine &lt; 292 mmol\/L, smoking cessation, and MRSA nasal screening all showed strong evidence on reducing PJI risk. Intraoperatively, a weight-based antibiotic prophylaxis, accurate fluid resuscitation, betadine and chlorhexidine dual skin preparation, diluted povidone iodine solution irrigation, tranexamic acid administration, and monofilament barbed triclosan-coated sutures for soft tissues closure all represented effective prevention measures. In the postoperative period, failure to reach normalization of ESR, CRP, D-dimer, and IL-6 six weeks postoperatively suggested early PJI. Conclusion: The current recommendations from this group of experts, based on published evidence, support risk stratification to identify high-risk patients requiring implementation of perioperative measures to reduce postoperative PJI.<\/jats:p>","DOI":"10.3390\/tropicalmed5040186","type":"journal-article","created":{"date-parts":[[2020,12,13]],"date-time":"2020-12-13T23:39:36Z","timestamp":1607902776000},"page":"186","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":75,"title":["Prevention of Periprosthetic Joint Infection (PJI): A Clinical Practice Protocol in High-Risk Patients"],"prefix":"10.3390","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0988-5258","authenticated-orcid":false,"given":"Ferdinando","family":"Iannotti","sequence":"first","affiliation":[{"name":"Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Prati","sequence":"additional","affiliation":[{"name":"ASST Bergamo Ovest, 24047 Ospedale Treviglio, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7766-0806","authenticated-orcid":false,"given":"Andrea","family":"Fidanza","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Bioengineering, Stanford University School of Medicine, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1599-7096","authenticated-orcid":false,"given":"Raffaele","family":"Iorio","sequence":"additional","affiliation":[{"name":"Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Ferretti","sequence":"additional","affiliation":[{"name":"Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"P\u00e8rez Prieto","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Hospital del Mar, Universitat Aut\u00f2noma de Barcelona, 08003 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nanne","family":"Kort","sequence":"additional","affiliation":[{"name":"CortoClinics, 5482 Schijndel, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Violante","sequence":"additional","affiliation":[{"name":"Orthopaedic Department, Istituto Clinico Sant\u2019Ambrogio IRCCS Galeazzi, 20161 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gennaro","family":"Pipino","sequence":"additional","affiliation":[{"name":"Ospedali Privati Riuniti Villa Regina, 40136 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfredo","family":"Schiavone Panni","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Specialties and Dentistry, University of Campania \u201cLuigi Vanvitelli\u201d, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hirschmann","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Mugnaini","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Ospedale Santa Maria Annunziata Asl Toscana Centro, 50012 Firenze, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4752-8027","authenticated-orcid":false,"given":"Pier Francesco","family":"Indelli","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery and Bioengineering, Stanford University School of Medicine, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,12,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1016\/j.arth.2016.09.027","article-title":"In-Hospital Mortality in Patients with Periprosthetic Joint Infection","volume":"32","author":"Shahi","year":"2017","journal-title":"J. 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