High Risk Patient in Arthroplasty

Co-morbidities of the patient significantly influence the risk for an infection.1 As periprosthetic joint infection (PJI) has a large impact on patient´s quality of life and is accompanied by high healthcare costs2, co-morbidities of the patient should be considered when choosing the optimal treatment algorithm.

Identifying risk factors together with preoperative optimisation of these co-morbidities, wherever possible, ensures the operation is performed under optimal conditions for the best patient outcome.

The use of a dual antibiotic-loaded bone cement (COPAL® G+C) can additionally reduce the risk for developing a PJI after primary hip or knee arthroplasty in patients with an exclusive risk profile.3

Reduction of infection risk by 34% using COPAL® G+C

PJI reduction from 3.7% to 2.45% with COPAL® G+C in high risk patients
Source: Figure adapted from Sanz-Ruiz & Berberich (2020)

Sanz-Ruiz & Berberich (2020) reported a PJI reduction from 3.7% to 2.45% in primary hip & knee arthroplasty with COPAL® G+C in high risk patients.

With a minimum follow-up period of 1 year, a PJI rate of 3.7% was found in the PALACOS® R+G cohort and a PJI rate of 2.45% in the COPAL® G+C cohort with an exclusive high-risk profile (n = 2551).

Good to know

Calculate the patients´ risk for infection

Definition of risk for infection patient according to Sanz-Ruiz & Berberich (2020)
Definition of risk for infection patient according to Sanz-Ruiz & Berberich (2020)

In a risk-adapted approach and to effectively prevent PJI when facing a risk for infection patient, it is necessary to clarify who is really considered a risk for infection patient.

According to Sanz-Ruiz & Berberich (2020) a patient at high risk for PJI is defined as follows:3

  • Combination of 3 or more risk factors in elective primary THA/trauma hip surgery
  • Combination of 2 or more risk factors in elective primary TKA

Other tools like for example the PJI risk calculator of the International Consensus group (ICM Philly) can also help to identify patients that are at higher risk to develop a PJI. To find out more about the ICM – PJI risk calculator, you can follow the link below:

Risk-adapted approach in arthroplasty

Excerpt from the ScienceCast

In a risk-adapted approach dual antibiotic-loaded bone cements play an important role in prevention of infection in high risk primary procedures, aseptic revision arthroplasty and fractured neck of femur. Dual antibiotic-loaded bone cements offer a broad effectiveness against the pathogens commonly causing an infection and prevent periprosthetic joint infections.

Prof. Volker Alt from University Hospital Regensburg for example believes “…that in those patients at risk the improvement of the local antibiotic prophylaxis with the use of two antibiotics at a higher dosage is really beneficial for the patients resulting in a postoperative lower infection rate”.

Watch the full ScienceCast with Volker Alt and Pablo Sanz-Ruiz by clicking here .

1 Eder A. et al, Risk factors for Superficial Side Infections after Total Hip Arthroplasty. Universal Journal of Medical Science 6(2): 9-13, 2018

2 Löwik CAM. et al. Obese patients have higher rates of polymicrobial and Gram-negative early periprosthetic joint infections of the hip than non-obese patients. PLoSOne. 2019 Apr 8; 14(4): e0215035.

3 Sanz-Ruiz P., Berberich C. Infection Risk-Adjusted Antibiotic Prophylaxis Strategies in Arthroplasty: Short Review of Evidence and Experiences of a Tertiary Center in Spain. Orthop Res Rev. 2020 Aug 6; 12: 89-96.