What Are Modifiable Risk Factors in Total Joint Arthroplasty? The Evidence.

The study of modifiable risk factors and preoperative optimization is critical to improving outcomes of total joint arthroplasty and lowering complications and the cost of care. Multiple attempts were made by the American Association of Hip and Knee Surgeons and the American Academy of Orthopaedic Surgeons to offer clinical practice guidelines based on the available literature. However, high-quality evidence to support that any comorbidity, including obesity, represents a modifiable risk for prosthetic joint infection was lacking. It is important to examine these guidelines, review the more recent literature, and discuss the practicality of evidence-based medicine when the quality of evidence is limited and also discuss the five conditions necessary to consider any disorder a modifiable risk factor.