{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T02:07:45Z","timestamp":1791943665799,"version":"4.3.4"},"reference-count":0,"publisher":"PAGEPress Publications","issue":"2","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Transl Myol"],"abstract":"<jats:p>Periprosthetic Joint Infection (PJI) remains one of the most serious and challenging complications following Total Knee Arthroplasty (TKA), with a substantial impact on patient outcomes and healthcare systems. Despite advances in surgical techniques and perioperative management, the incidence of PJI has not significantly declined, highlighting the need for more effective preventive strategies. This review aims to provide a comprehensive and clinically oriented overview of current infection prevention strategies in TKA, with a particular focus on risk stratification, perioperative optimization, and the development of a practical clinical algorithm to guide decision-making. A narrative review of the literature was conducted using major medical databases to identify relevant studies on PJI prevention in TKA. Priority was given to recent systematic reviews, meta-analyses, and high-quality clinical studies addressing patient-related risk factors, intraoperative measures, and postoperative management. PJI is a multifactorial complication influenced by the interaction between patient-related, surgical, and postoperative factors. Modifiable risk factors such as obesity, diabetes, malnutrition, and smoking play a pivotal role and should be optimized preoperatively. Intraoperative strategies, including strict aseptic technique, appropriate antibiotic prophylaxis, and minimization of operative time, are essential to reduce contamination risk. Postoperative measures focusing on wound management, hematoma prevention, and early detection of complications further contribute to infection prevention. Several aspects remain controversial, including the role of laminar airflow systems, antibiotic-loaded bone cement in primary TKA, and optimal decolonization strategies for Staphylococcus aureus. Effective prevention of PJI requires a structured, multimodal approach integrating all phases of care. Risk stratification enables personalized preventive strategies and improved perioperative planning. The clinical algorithm proposed in this review provides a practical framework to support decision-making and may help standardize infection prevention pathways. Future research should focus on validating risk-based approaches and emerging technologies to further reduce the burden of PJI in TKA.<\/jats:p>","DOI":"10.4081\/ejtm.2026.15177","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:01:01Z","timestamp":1779753661000},"source":"Crossref","is-referenced-by-count":2,"title":["Infection prevention in total knee arthroplasty: current concepts, controversies, and a clinical algorithm"],"prefix":"10.4081","volume":"36","author":[{"given":"Giuseppe","family":"Rovere","sequence":"first","affiliation":[{"name":"Department of Surgical Sciences, Policlinico Tor Vergata University Hospital, Rome; Department of Clinical Sciences and Translational Medicine, Section of Orthopaedic and Traumatology, University of Rome Tor Vergata, Roma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Bosco","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-7339-1772","authenticated-orcid":true,"given":"Claudia","family":"Cuttaia","sequence":"additional","affiliation":[{"name":"Catholic University of the Sacred Heart, Rome"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9514-9304","authenticated-orcid":true,"given":"Ludovico","family":"Lucenti","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3669-189X","authenticated-orcid":true,"given":"Luigi","family":"Meccariello","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, AORN San Pio Hospital, Benevento"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8742-5612","authenticated-orcid":true,"given":"Michele","family":"Mercurio","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Trauma Surgery, \"Magna Graecia\" University, \"Mater Domini\" University Hospital, Catanzaro"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7766-0806","authenticated-orcid":true,"given":"Andrea","family":"Fidanza","sequence":"additional","affiliation":[{"name":"Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Cristiano","sequence":"additional","affiliation":[{"name":"Studio Radiologico S. Domenico, Lamezia Terme"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2163-454X","authenticated-orcid":true,"given":"Giuseppe","family":"Marongiu","sequence":"additional","affiliation":[{"name":"Orthopaedic and Trauma Clinic, Department of Surgical Sciences, Policlinico Duilio Casula, Cagliari State University, Cagliari"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amarildo","family":"Smakaj","sequence":"additional","affiliation":[{"name":"U.O.C. of Orthopaedics and Traumatology, Bambino Ges\u00f9 Children's Hospital, IRCCS, Rome; Link Campus University, Rome"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"De Mauro","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Ageing and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Perna","sequence":"additional","affiliation":[{"name":"Unit\u00e0 di Chirurgia Vertebrale, Dipartimento di Ortopedia e Traumatologia, Fondazione Casa Sollievo Della Sofferenza IRCCS, San Giovanni Rotondo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasquale","family":"Farsetti","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Translational Medicine, Section of Orthopaedic and Traumatology, University of Rome Tor Vergata, Roma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"De Maio","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Translational Medicine, Section of Orthopaedic and Traumatology, University of Rome Tor Vergata, Roma"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Camarda","sequence":"additional","affiliation":[{"name":"Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2549","published-online":{"date-parts":[[2026,5,25]]},"container-title":["European Journal of Translational Myology"],"original-title":[],"link":[{"URL":"https:\/\/www.pagepressjournals.org\/bam\/article\/download\/15177\/14109","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.pagepressjournals.org\/bam\/article\/download\/15177\/14109","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T00:07:37Z","timestamp":1783123657000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.pagepressjournals.org\/bam\/article\/view\/15177"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,25]]},"references-count":0,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6,30]]}},"URL":"https:\/\/doi.org\/10.4081\/ejtm.2026.15177","relation":{},"ISSN":["2037-7460","2037-7452"],"issn-type":[{"value":"2037-7460","type":"electronic"},{"value":"2037-7452","type":"print"}],"subject":[],"published":{"date-parts":[[2026,5,25]]}}}