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Obesity increases the risk of deep infection after total joint arthroplasty (TJA). Our objective was to determine whether there may be body mass index (BMI) and weight thresholds indicating a higher prosthetic joint infection rate.We included all 9,061 primary hip and knee arthroplasties (mean age 70 years, 61% women) performed between March 1996 and December 2013 where the patient had received intravenous cefuroxime (1.5 g) perioperatively. The main exposures of interest were BMI (5 categories: < 24.9, 25-29.9, 30-34.9, 35-39.9, and ≥ 40) and weight (5 categories: < 60, 60-79, 80-99, 100-119, and ≥ 120 kg). Numbers of TJAs according to BMI categories (lowest to highest) were as follows: 2,956, 3,350, 1,908, 633, and 214, respectively. The main outcome was prosthetic joint infection. The mean follow-up time was 6.5 years (0.5-18 years).111 prosthetic joint infections were observed: 68 postoperative, 16 hematogenous, and 27 of undetermined cause. Incidence rates were similar in the first 3 BMI categories (< 35), but they were twice as high with BMI 35-39.9 (adjusted HR = 2.1, 95% CI: 1.1-4.3) and 4 times higher with BMI ≥ 40 (adjusted HR = 4.2, 95% CI: 1.8-9.7). Weight ≥ 100 kg was identified as threshold for a significant increase in infection from the early postoperative period onward (adjusted HR = 2.1, 95% CI: 1.3-3.6).BMI ≥ 35 or weight ≥ 100 kg may serve as a cutoff for higher perioperative dosage of antibiotics.

Original publication

DOI

10.3109/17453674.2015.1126157

Type

Journal article

Journal

Acta orthopaedica

Publication Date

05/01/2016

Volume

87

Pages

132 - 138

Addresses

a Division of Orthopedics and Trauma Surgery , Geneva University Hospitals and Faculty of Medicine, University of Geneva , Geneva , Switzerland .

Keywords

Humans, Prosthesis-Related Infections, Body Weight, Cefuroxime, Anti-Bacterial Agents, Body Mass Index, Treatment Outcome, Antibiotic Prophylaxis, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, Incidence, Risk Factors, Follow-Up Studies, Prospective Studies, Adolescent, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, Young Adult