Incidence and risk factors for surgical site infection following total knee arthroplasty: a systematic review and meta-analysis

To identify the risk factors for postoperative surgical site infection (SSI) following total knee arthroplasty (TKA), a systematic search was performed in three databases: Pubmed, Embase, and Cochrane library databases until February 2016. Pooled odds ratios (ORs) or standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using random- or fixed-effects model. Patient-related factors, surgical-related factors and comorbidity were investigated. Fourteen studies were selected for the current meta-analysis. The pooled infection rate was 0.90% (95% CI, 0.30% to 1.50%). Factors associated with infection after TKA were male gender (OR, 2.23; 95% CI, 1.71 to 2.91), age (SMD, -0.11; 95% CI, -0.19 to -0.02), obesity (OR, 1.25; 95% CI, 1.06 to 1.48), smoking (OR, 2.57; 95% CI, 1.50 to 4.39), American society of anesthesiologists scale (ASA) > 2 (OR, 1.79; 95% CI, 1.50 to 2.15), operative time (SMD, 0.44; 95% CI, 0.26 to 0.63), transfusion (OR, 1.54; 95% CI, 1.18 to 2.02), and diabetes mellitus (OR, 1.51; 95% CI, 1.17 to 1.95). No sufficient evidences reveal that steroid use, bilateral surgery, drain usage, bone graft, urinary tract infection, hypertension, and rheumatoid arthritis lead to infection after TKA. This information could be used to prevent the onset of infection after TKA.