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High Risk Patient in Arthroplasty

Co-morbidities of the patient significantly influence the risk for an infection.1 As periprosthetic joint infection (PJI) has a large impact on patient´s quality of life and is accompanied by high healthcare costs2, co-morbidities should be considered when choosing the optimal treatment algorithm.

 

High Risk Patient

Identifying risk factors together with preoperative optimisation of these co-morbidities, wherever possible, ensures the operation is performed under optimal conditions for the best patient outcome.

The use of a dual antibiotic-loaded bone cement (COPAL® G+C) can additionally reduce the risk for developing a PJI after primary hip or knee arthroplasty in patients with an exclusive risk profile.3

Reduction of Infection Risk by 34% Using COPAL® G+C

Sanz-Ruiz & Berberich (2020) reported a PJI reduction from 3.7% to 2.45% in primary hip & knee arthroplasty with COPAL® G+C in high risk patients.

With a minimum follow-up period of 1 year, a PJI rate of 3.7% was found in the PALACOS® R+G cohort and a PJI rate of 2.45% in the COPAL® G+C cohort with an exclusive high-risk profile (n = 2551).

PJI reduction from 3.7% to 2.45% with COPAL G+C in high risk patients. PALACOS R+G group: n = 2368 (low and high risk patients according to a defined algorithm); COPAL G+C group: n = 183 (exclusively high risk patients according to a defined algorithm)
PJI reduction from 3.7% to 2.45% with COPAL G+C in high risk patients. PALACOS R+G group: n = 2368 (low and high risk patients according to a defined algorithm); COPAL G+C group: n = 183 (exclusively high risk patients according to a defined algorithm)
COPAL® G+C

High-viscosity bone cement with gentamicin and clindamycin

Learn more about COPAL G+C
Image of COPAL G+C bone cement package
Bone Cement

Calculate the Patients´ Risk for Infection

There are various risk factors that increase the chance of infection in primary and revision arthroplasty. According to OECD, 6 out of 10 patients aged 65 and older likely present with at least 2 risk factors for infection.4 
Every patient brings with them individual factors which may imply a potential risk for infection. The risk factors obesity, diabetes and cardiovascular disease have been selected for a closer look in our Infosheet.

In a risk-adapted approach and to effectively prevent PJI when facing a risk for infection patient, it is necessary to clarify who is really considered a risk for infection patient.

According to Sanz-Ruiz & Berberich (2020) a patient at high risk for PJI is defined as follows:5

  • Combination of 3 or more risk factors in elective primary THA/trauma hip surgery
  • Combination of 2 or more risk factors in elective primary TKA
Definition of risk for infection patient according to Sanz-Ruiz & Berberich (2020)
Definition of risk for infection patient according to Sanz-Ruiz & Berberich (2020)

Other tools like for example the PJI risk calculator of the International Consensus group (ICM Philly) can also help to identify patients that are at higher risk to develop a PJI.

Risk-Adapted Approach in Arthroplasty

In a risk-adapted approach dual antibiotic-loaded bone cements play an important role in prevention of infection in high risk primary procedures, aseptic revision arthroplasty and fractured neck of femur. Dual antibiotic-loaded bone cements offer a broad effectiveness against the pathogens commonly causing an infection and prevent periprosthetic joint infections.

Prof. Volker Alt from University Hospital Regensburg for example believes “…that in those patients at risk the improvement of the local antibiotic prophylaxis with the use of two antibiotics at a higher dosage is really beneficial for the patients resulting in a postoperative lower infection rate”.

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Watch the full ScienceCast with Volker Alt and Pablo Sanz-Ruiz by clicking here.