Suggestions for practice modificationsa
| Identify higher-risk patients |
| Olderage11,12,16,17,26,28,,81 |
| Higher body mass index10–12,17,18,74 |
| Diabetes mellitus10,12,17,20 |
| Higher comorbidity: cardiovascular disease, hypertension, liver disease, pulmonary disease, higher American Society of Anesthesiologists score7,8,10,19,24,74,81 |
| Chronic kidney disease7,11–13,15,19,29 |
| Benign heart murmurs28 |
| Consider the following in higher-risk cases of primary total joint arthroplasty or any periprosthetic joint infection |
| Hold renin-angiotensin-aldosterone system blockers perioperatively11,18,24,75 |
| Avoid perioperative blood transfusion10,29,73 |
| Correct anemia preoperatively if possible17,74 |
| Avoid aminoglycoside prophylaxis unless needed for periprosthetic joint infection21–25 |
| Avoid perioperative nonsteroidal anti-inflammatory drugs73 |
| Play close attention to postoperative urine output |
| Follow serum creatinine daily for at least 48–72 hours |
| Additional modifications in cases of prosthetic joint infection |
| Avoid systemic aminoglycosides unless needed for microbiologic reasons |
| Avoid the combination of systemic vancomycin with piperacillin-tazobactam75,84 |
| Determine the amount of antibiotics per 40-g bag of antibiotic-loaded cement and the number of bags used69 |
| Check serum levels of vancomycin and aminoglycosides if contained in the cement |
↵a Based on the authors’ opinions, given only level III or IV scientific evidence with supporting references.