Risk Factors for Infection After Ankle, Knee, Hip, Shoulder, or Elbow Arthroscopy: A Systematic Review and Meta-analysis.

Abstract

Arthroscopy is a commonly performed orthopaedic procedure with postoperative infection risk factors including male sex, tobacco use, and preoperative steroid injections. However, studies focusing on risk factors are limited to single joints with limited numbers of patients; therefore, inconsistencies remain. To review and analyze predictive risk factors for postarthroscopy infections across arthroscopy of the ankle, knee, hip, shoulder, and elbow. Systematic review and meta-analysis; Level of evidence, 3. The PubMed, Scopus, and Embase databases were searched using terms related to "arthroscopy" and "infection" to determine risk associated with patient-specific factors. Pooled analysis was conducted using R for smoking, diabetes mellitus (DM), body mass index (BMI) between 30 and 40, BMI >40, intraoperative corticosteroid injection (CSI), and preoperative CSI administration at 2-week intervals up to 8 weeks before operation. The search included 1384 studies, of which 125 were determined to meet all inclusion criteria. Postarthroscopic infection risk is significantly increased in patients who had intraoperative intra-articular steroid use (OR, 5.97; 95% CI, 2.66-13.39), steroid use within 2 weeks (OR, 3.36; 95% CI, 2.43-4.65) and 2 to 4 weeks before operation (OR, 1.89; 95% CI, 1.48-2.42), DM (OR, 1.49; 95% CI, 1.24-1.79), BMI of 30 to 40 (OR, 1.29; 95% CI, 1.22-1.37), and BMI >40 (OR, 1.76; 95% CI, 1.41-2.19) and patients who smoked tobacco (OR, 1.59; 95% CI, 1.38-1.83).The overall risk of infection was 0.84%. Across joints, infection rates varied by procedure type. Knee and hip surgeries demonstrated low weighted mean infection rates (0.61% and 0.59%, respectively), as did shoulder procedures (0.47%). Elbow surgeries had the highest mean infection rate (2.3%), and limited data suggested a low rate for ankle procedures (0.27%). Significant increases in postoperative infection risk in patients who underwent arthroscopy of the ankle, knee, hip, shoulder, and elbow were noted with intraoperative intra-articular CSI administration or preoperative CSI administration within 4 weeks of surgery, BMI >30, diabetes, and smoking tobacco. Given the prevalence of these risk factors, patient-specific considerations and interventions should be used to mitigate risk and improve patient outcomes.