Greater Risk of Periprosthetic Joint Infection Associated with Prolonged Operative Time in Primary Total Knee Arthroplasty: Meta-Analysis of 427,361 Patients

Abstract

Background/Objectives: Periprosthetic joint infection (PJI) is a severe complication in total knee arthroplasty (TKA) with catastrophic outcomes. The relationship between prolonged operative times and PJI remains debated. This meta-analysis investigated the link between prolonged operative times and the risk of PJI in primary TKA. Methods: A comprehensive search of the MEDLINE/PubMed, Cochrane Library, and EMBASE databases was conducted to identify studies comparing the incidence of PJI in TKAs with prolonged versus short operative times, as well as those comparing operative times in TKAs with and without PJI. Pooled standardized mean differences (SMD) in operative times between groups with and without PJI or surgical site infections (SSI), including superficial SSIs and PJIs, were analyzed. Additionally, the pooled odds ratios (OR) for PJI in TKAs with operative times exceeding 90 or 120 min were examined. Results: Seventeen studies involving 427,361 patients were included. Significant differences in pooled mean operative times between the infected and non-infected TKA groups were observed (PJI, pooled SMD = 0.38, p < 0.01; SSI, pooled SMD = 0.72, p < 0.01). A higher risk of PJI was noted in surgeries lasting over 90 or 120 min compared to those of shorter duration (90 min, pooled OR = 1.50, p < 0.01; 120 min, pooled OR = 1.56, p < 0.01). Conclusions: An association between prolonged operative time and increased risk of PJI in primary TKA has been established. Strategies for infection prevention should encompass thorough preoperative planning aimed at minimizing factors that contribute to prolonged operative times.

Keywords: operative time; periprosthetic joint infection; prosthesis-related infections; surgical wound infection; total knee arthroplasty.

Figure 1

PRISMA flow diagram. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Figure 2

Forest plots showing the operative times of patients with and without surgical site infection. CI, confidence interval; SE, standard error; SMD, standardized mean difference.

Figure 3

Forest plots showing the operative times of patients with and without periprosthetic joint infection. CI, confidence interval; SE, standard error; SMD, standardized mean difference.

Figure 4

Forest plots comparing the incidence of periprosthetic joint infection in patients with operative times ≥90 min vs. <90 min. CI, confidence interval; OR, odds ratio; SE, Standard error.

Figure 5

Forest plots comparing the incidence of periprosthetic joint infection between patients with operative times of ≥120 and <120 min. CI, confidence interval; OR, odds ratio; SE, Standard error.