Suggestions for practice modificationsa

Identify higher-risk patients
 Higher body mass index1012,17,18,74
 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 disease7,1113,15,19,29
 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 infection2125
 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.