Periprosthetic Joint Infection Following Clean Hand Surgery: A Systematic Review

PURPOSE: We assessed the rate of periprosthetic joint infection (PJI) following hand surgery in patients with prosthetic joints, and determined the efficacy of prophylactic antibiotics for preventing PJI in this patient subset. METHODS: A systematic review of PubMed (MEDLINE) and Scopus (EMBASE, MEDLINE, COMPENDEX) from 1968 to 2021 was conducted. Primary articles that studied PJIs following hand surgery in patients with prosthetic joints (hip, knee, shoulder, elbow, or ankle) and/or the use of prophylactic antibiotics prior to hand surgery in patients with prosthetic joints were included. RESULTS: A total of 3 studies (439,080 patients) met our inclusion criteria. Of the total study population, 9,070 patients (2.1%) had a prior total joint arthroplasty treated and subsequently underwent soft-tissue hand surgery. A single study reported a 0.2% prevalence of PJI secondary to hand surgery. The remaining 2 studies found no cases of PJI following hand surgery in patients with a history of total joint arthroplasty. On average, 16% (1,214 of 7,374) of patients with prosthetic joints received antibiotics prior to hand surgery. No significant relationships were found between hand surgery, antibiotic prophylaxis, and PJI risks. CONCLUSIONS: There is a very low reported incidence of PJI following hand surgery in patients with existing prosthetic joints, with or without the use of prophylactic antibiotics. Therefore, the authors do not recommend the routine use of prophylactic antibiotics in this patient subgroup. The decision to use prophylaxis should be made on a case-by-case basis, accounting for patient-specific comorbidities and risk factors. Further research on hand surgery–associated PJI is warranted. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.