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Risk factors in prosthetic hip/knee joint replacement infections incidence and patient outcomes

Bojan, Bsmah 2023. Risk factors in prosthetic hip/knee joint replacement infections incidence and patient outcomes. PhD Thesis, Cardiff University.
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Background: Periprosthetic joint infection (PJI) is a severe complication following total joint arthroplasty which is associated with mortality and morbidity risks. Perioperative identification of modifiable and not modifiable PJI risk factors is essential for educating patients on their risks of complication and improving surgical decision-making. Aims: 1. Examining the association between uncertain variables of smoking, intraarticular steroid injection, anticoagulants and fixation types, and risk of PJI in hip arthroplasty. 2. Identifying risk factors of PJI in total hip and knee joint replacement surgery in the UK. Methods: • Systematic review and meta-analysis. Systematic search conducted through MEDLINE, EMBASE, CINAHL and Cochrane databases. Odds ratio (OR) with 95% confidence interval (CI) using random effect models utilised. • Conducting a retrospective observational study involving 91,038 hip or knee joint replacements performed between 2007-2019 in England and Wales. Investigating the association between PJI risk and patient characteristics, medical and treatment histories, and surgery characteristics using Cox proportional hazards. Data obtained from Clinical Practice Research Datalink linked to Hospital Episode Statistics data. Results: • Overall OR to develop PJI for steroid injection is 2.12 (95% CI 0.58-7.72, p = 0.250); smoking is 1.54 (95% CI 1.25-1.91, p < 0.05). The systematic search found no association between anticoagulants and PJI risk, while it was difficult to draw conclusions regarding fixation method due to inconsistencies in the literature. • For THA, DM, active cancer, hypertension, using NSAIDs and DMARDs < 3 months were risk factors for PJI. Male gender, BMI 25-30 kg/m2, DM, active cancer, using NSAIDs < 3 months were risk factors for PJI following TKA. Conclusion: This study's findings provide information that allows healthcare providers to develop and incorporate preventative strategies for PJI for patients undergoing TKA/THA in clinical practice.

Item Type: Thesis (PhD)
Date Type: Completion
Status: Unpublished
Schools: Pharmacy
Subjects: Q Science > Q Science (General)
Date of First Compliant Deposit: 19 December 2023
Last Modified: 19 Dec 2023 16:47

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