The present study provides information that local antibiotic prophylaxis may have a greater influence on the prevention of acute PJI in patients with non-modifiable risk factors. Nevertheless, there were some limitations, the first one is that this study only evaluates acute joint infections from postoperative to 3 months, and no cases of chronic infection were considered. Another limitation was that the guidelines for PJI diagnosis could not be followed using biomarkers like d-dimer, Alpha-defensin, and histologic analysis [
- Shohat N.
- Bauer T.
- Buttaro M.
- et al.
Hip and knee section, what is the definition of a periprosthetic joint infection (PJI) of the knee and the hip? Can the same criteria be used for both joints?: proceedings of international consensus on orthopedic infections.
]. Therefore, the diagnosis was made by CRP and ESR biomarkers, as well as synovial white blood cell count and culture. In our country, the socio-cultural conditions of the population do not allow adequate knowledge of diseases, leading to underestimation of repercussions on their health conditions due to poor adherence in their treatments. We have found in this study that some patients who require surgical joint replacement treatment do not have adequate control of their chronic conditions, increasing the risk of infection by having risk factors that cannot be modified in the short or medium term [
- Iorio R.
- Williams K.M.
- Marcantonio A.J.
- Specht L.M.
- Tilzey J.F.
- Healy W.L.
Diabetes mellitus, hemoglobin A1C, and the incidence of total joint arthroplasty infection.
]. Although adequate preoperative preparation is mandatory, in our population, it is not feasible to control all the risk factors because of our socio-cultural environment [
- Barrera-Cruz A.
- Rodríguez-González A.
- Molina-Ayala M.A.
The current state of obesity in Mexico Escenario actual de la obesidad en México.
]. Despite this, in many cases, replacement surgery is necessary to provide a better quality of life [
- Boyce L.
- Prasad A.
- Barrett M.
- et al.
The outcomes of total knee arthroplasty in morbidly obese patients: a systematic review of the literature.
]. During the trial, 367 arthroplasties were carried out, including primary and revisions, and 280 of them did not comply with the eligibility criteria; therefore, 83 participants with non-modifiable risk factors for PJI risk were enrolled. Once the acute infection has been diagnosed, the treatment that follows is complex and not without complications; in patients, who also have risk factors or active diseases, treatment becomes even more difficult and expensive [
- Pierce A.Z.
- Menendez M.E.
- Tybor D.J.
- Salzler M.J.
Three different databases, three different complication rates for knee and hip arthroplasty: comparing the National Inpatient Sample, National Hospital Discharge Survey, and National Surgical Quality Improvement Program, 2006 to 2010.
In previous years, we found that the prevalence of PJI in our institution was very high compared with the international references; for this reason, we initiated protocols to reduce this prevalence found among some procedures, like the local application of antibiotics, which has been studied on several occasions [
- Vélez-de Lachica J.C.
- Santos-Briones J.I.I.-S.J.
Aplicación profiláctica de sulfato de calcio medicado en prótesis total de cadera no cementada.
]. However, the direct application to the prosthetic bone interface areas has not yet been well established. In the present research, we were able to identify that the application of a local antibiotic in contact with the prosthetic components and surrounding tissue is beneficial for patients. Periprosthetic infections will continue to be an issue with devastating consequences for the patient, the surgeon, and the health system.
Similar findings were reported by Parvizi et al. showing that one of the greatest challenges in PJI prevention is risk factor recognition, whether modifiable or non-modifiable. Recognition of these factors will allow us to focus on better prevention strategies [
- Alijanipour P.
- Heller S.
- Parvizi J.
Prevention of periprosthetic joint infection: what are the effective strategies?.
]. Michael M. Kheir et al. have also published the relationship between risk factors and the increased susceptibility to infection, as well as antibiotic prophylaxis, and their study demonstrates that extended oral antibiotic prophylaxis by seven days postoperatively may reduce the prevalence of infection by counteracting poor host factors up to one year [
- Kheir M.M.
- Dilley J.E.
- Ziemba-Davis M.
- Meneghini R.M.
The AAHKS Clinical Research Award: extended oral antibiotics prevent periprosthetic joint infection in high-risk cases: 3855 patients with 1-year follow-up.
]. The present study found that medicated calcium sulfate beads, when used as a local release method of prophylactic antibiotic therapy, have the potential to reduce PJI in patients with non-modifiable risk factors by 86.6%, as well as their associated complications and economic burden; however, more studies are required to corroborate long-term results.