How to identify the patient at risk of hip periprosthetic joint infections

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INTRODUCTION: Preoperative risk stratification and targeting potentially modifiable risk factors could reduce the complications rate in total joint arthroplasty (TJA). Moreover, the increased pressure on cost containment and recent strain on health systems through the pandemic highlight the need for process optimization. The present work aims to provide an up-to-date review concerning the preoperative identification of patients at risk for TJA.EVIDENCE ACQUISITION: A literature review searching Medline (through PubMed), Embase, Ovid, Cochrane library and Google Scholar was performed, searching combinations of keywords including “preoperative,” “risk factor,” “total joint arthroplasty” and/or “arthroplasty.” Moreover, the following guidelines were examined: the European hip/knee/anesthesiology societies, 2nd international consensus meeting on musculoskeletal infection (2019), Centers for Disease Control and Prevention and AAOS.EVIDENCE SYNTHESIS: Modifiable and non-modifiable risk factors are described, accordingly subdivided into local or general factors. The quantification of the single and aggregated variables is discussed, however is highly variable according to literature. To compute the risk “on-field”, more than one statistical method is available for the clinical practice.CONCLUSIONS: Patients’ preoperative risk analysis and stratification are universally recommended, they optimize patients counselling and resource allocation. Every modifiable factor must be addressed, to achieve the foremost risk mitigation. Moreover, considering the drift towards bundle-paying models, it should be considered for refunding issues. For the clinical practice, dedicated preoperative scores and on-line computational facilities are available, leading to evidence-based preoperative protocols for optimization of modifiable risk factors and overall improved outcomes.