Correlation between Body Mass Index and Periprosthetic Joint Infection following Total Joint Arthroplasty: A protocol for systematic review and meta analysis.

ABSTRACT

BACKGROUND: Despite rapid reports on the correlation between body mass index (BMI) and periprosthetic joint infection (PJI) after total joint arthroplasty, some have conducted regression tests or meta-analyses with controversial results. In this study, we systematically meta-analyzed relevant trials and carefully evaluated the correlation for verification. METHODS: Literature on the correlation between BMI and PJI following total joint arthroplasty was retrieved in PubMed, Embase and Cochrane Library due September 2019. Stata 13.0 software was adopted for data synthesis and analyses of publication bias and sensitivity. Random-effect models were used to summary the overall estimate of the multivariate adjusted odds ratio (OR)/hazard ratio/rate ratio with 95% confidence intervals (CIs). RESULTS: A total of 29 observational studies representing 3,204,887 patients were included. The meta-analysis revealed that the risk of postoperative PJI significantly increased by 1.51 times in the obese group (OR = 1.51; 95% CI = 1.30-1.74 for the obese group vs. the non-obese group), and by 3.27 times in the morbid obese group (OR = 3.27; 95% CI = 2.46-4.34 for the morbid obese group vs the non-morbid obese group). A significant association remained consistent, as indicated by subgroup analyses and sensitivity analyses. CONCLUSION: Our findings demonstrate that postoperative PJI is positively correlated with BMI, with obese patients showing a greater risk of developing PJI than non-obese patients. Similarly, morbid obese patients present a higher risk of PJI than non-morbid obese patients. However, this conclusion needs to be corroborated by more prospective studies.