Factors Associated With Surgical Site Infections in Adults Following a Replacement of Weight-Bearing Joints: A Systematic Review

Abstract

Surgical site infection may occur within 90-days following joint replacement surgery and, in patients undergoing weight-bearing joint replacement, can complicate recovery and adversely affect quality of life. Although numerous studies have identified factors associated with surgical site infections, synthesised and comprehensive evidence specific to weight-bearing arthroplasty remains limited. This systematic review determined the epidemiological associations between intrinsic and extrinsic factors and the development of surgical site infection in adults undergoing hip, knee and/or ankle arthroplasty, using the JBI methodology for systematic reviews of aetiology and risk, and was registered with PROSPERO (CRD42023482491). Studies were retrieved from CINAHL, Medline, Embase, Emcare, the Cochrane Library, and reference lists. English-language observational studies reporting associations between one or more risk factors and surgical site infection following weight-bearing joint replacement were eligible for inclusion. All included studies underwent methodological quality appraisal. Fifty-seven studies met the inclusion criteria. The number of risk factors investigated varied across studies, ranging from a single factor to multiple factors, with multiple factors identified as being significantly associated with an increased risk of surgical site infections at the multivariable levels of analysis. This evidence indicates the need for comprehensive strategies to address these risk factors throughout the patient journey in arthroplasty.