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Review Article
* These authors contributed equally
This review summarizes how anesthetic techniques, perioperative infection-control practices, medication choices, and postoperative recovery strategies may influence surgical site infection and periprosthetic joint infection risk in hip and knee arthroplasty, emphasizing the anesthesiologist's contribution to perioperative infection prevention.
Surgical site infection (SSI) and periprosthetic joint infection (PJI) remain among the most serious complications after total hip and knee arthroplasty, potentially leading to delayed recovery, revision surgery, prolonged antimicrobial treatment, increased healthcare costs, and worse functional outcomes. This narrative review evaluates how perioperative anesthetic management may influence infection risk in patients undergoing hip and knee arthroplasty and summarizes practical measures that anesthesia providers can take to contribute to infection prevention. The review first compares general, neuraxial, and regional anesthetic techniques and their potential effects on immune function, neuroendocrine stress responses, tissue perfusion, oxygenation, and postoperative analgesic requirements. It then addresses aseptic practices relevant to the anesthesia work area during arthroplasty, including hand hygiene, glove use, safe medication preparation, management of airway and vascular equipment, skin antisepsis for anesthesia-related invasive procedures, and adherence to operating-room infection-control protocols. Drug-related considerations include timely antibiotic prophylaxis, the immunomodulatory and glycemic effects of dexamethasone, infection risks associated with improper propofol handling, and the potential influence of perioperative opioid exposure. Postoperative recovery strategies, including multimodal analgesia, early mobilization, and appropriate management of invasive devices, are also discussed. Finally, preoperative optimization strategies relevant to hip and knee arthroplasty are reviewed, including glycemic control, nutritional support, smoking cessation, anemia management, screening and decolonization for Staphylococcus aureus, and structured prehabilitation. Overall, prevention of SSI and PJI after hip and knee arthroplasty requires multidisciplinary, protocol-based perioperative care integrating anesthetic decision-making with established surgical, nursing, and infection-control measures.
Total hip arthroplasty and total knee arthroplasty are widely performed procedures that provide substantial pain relief and functional improvement for patients with advanced joint disease. Disease Study 2021, approximately 595 million people—7.6% of the global population—were living with osteoarthritis in 2020, representing an increase of more than 130% since 1990. By 2050, the number of people affected by osteoarthritis is projected to approach 1 billion, with cases of knee and hip osteoarthritis expected to increase by approximately 74.9% and 78.6%, respectively1. Despite improvements in surgical techniques, implant design, antimi....
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Literature search and selection strategy
This article was designed as a narrative review; therefore, a targeted literature search rather than a formal systematic review was performed. PubMed/MEDLINE, Web of Science, Scopus, Embase, and Google Scholar were searched for English-language articles published from January 2000 to January 2025. Search terms included combinations of “orthopedic surgery,” “hip arthroplasty,” “knee arthroplasty,” “surgical site infection,” “anesthesia,” “general anesthesia,” “spinal anesthesia,” “neuraxial anesthesia,” “r....
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Surgical site infection and periprosthetic joint infection after hip and knee arthroplasty are multifactorial complications. Anesthesiologists contribute to infection prevention through strict aseptic practice, timely antimicrobial prophylaxis, maintenance of normothermia, appropriate device management, multimodal analgesia, and optimization of modifiable patient risk factors.
Although neuraxial and regional anesthesia have been associated with lower infection rates in some studies, a direct c.......
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The authors declare that there is no conflict of interest.
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