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Philip F. Dobson Trauma and Orthopaedic Surgery, Royal Victoria Infirmary, Newcastle, UK

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Michael R. Reed Trauma and Orthopaedic Surgery, Royal Victoria Infirmary, Newcastle, UK

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arthroplasty (TKA) range between 0.3% and 1.9%, 3 and up to 10% in revision cases. 4 The risk of SSI and PJI is related to surgical factors and patient factors such as age, body mass index (BMI), co-morbidities, and lifestyle. 5 Significant

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Te-Feng Arthur Chou Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan

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Hsuan-Hsiao Ma Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan

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Shang-Wen Tsai Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan

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Cheng-Fong Chen Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan

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Po-Kuei Wu Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan

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Wei-Ming Chen Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
Department of Orthopaedics, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan

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arthroplasty surgery due to several risk factors such as morbid obesity, alcohol abuse, and poorly controlled diabetes. 2 , 3 In addition, these patients have been shown to have a higher mortality and morbidity rate following arthroplasty surgeries. 4

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Martin McNally The Bone infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK

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Irene Sigmund The Bone infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Austria

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Andrew Hotchen The Bone infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK

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Ricardo Sousa Porto Bone and Joint Infection Group (GRIP), Department of Orthopaedics, Centro Hospitalar Universitario Santo António and CUF-Hospitais e Clinicas, Portugal

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suggest that once the diagnosis of PJI has been established, it is valuable to classify cases to give insight into the efficacy of treatments and the contribution of risk factors for failure. Conclusion This review has highlighted the challenges

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Michael de Buys Orthopaedic Surgery, University of Witswatersrand, Johannesburg, South Africa

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Krisantha Moodley Emergency Department, ER Consulting, Johannesburg, South Africa

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Josip Nenad Cakic Department Orthopaedic Surgery, Life Fourways Hospital, Johannesburg, South Africa

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Jurek R T Pietrzak Orthopaedic Surgery, University of Witswatersrand, Johannesburg, South Africa

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). Risk factors for PJI Despite established perioperative infection control measures, patient-related predisposing factors continue to significantly influence the rates of PJI. Modifiable risk factors include obesity, smoking, alcohol abuse, malnutrition

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Stavros Tsotsolis Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, Thessaloniki, Greece
Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, Greece
Trauma and Orthopaedics Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK

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Eustathios Kenanidis Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, Thessaloniki, Greece
Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, Greece

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Vasileios F Pegios Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, Thessaloniki, Greece
Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, Greece

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Michael Potoupnis Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, Thessaloniki, Greece
Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, Greece

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Eleftherios Tsiridis Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, Thessaloniki, Greece
Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, Greece

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diagnosed with osteoarthritis, one of the most common joint disorders requiring TJA, are twice as likely to have comorbidities than a control group of the same age ( 7 , 8 ). Attention has recently focused on recognizing modifiable risk factors of

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Juan Carlos Monllau Department of Orthopaedic Surgery, Hospital del Mar, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
ICATKnee, Institut Catalá de Traumatologia i Medicina de l’Esport (ICATME), Hospital Universitari Dexeus, UAB, Barcelona, Spain

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Simone Perelli Department of Orthopaedic Surgery, Hospital del Mar, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
ICATKnee, Institut Catalá de Traumatologia i Medicina de l’Esport (ICATME), Hospital Universitari Dexeus, UAB, Barcelona, Spain

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Giuseppe Gianluca Costa Orthopaedic Surgery Department, Ospedale Umberto I, Enna, Italy

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compared with the uninjured side. Knee extension or flexion deficits represent a contraindication for ACL revision surgery ( 9 ) unless they are the result of a malpositioned graft. Knee hyperextension is a well-recognized risk factor for failure ( 59 , 60

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Claus Varnum The Danish Hip Arthroplasty Register
Department of Orthopaedic Surgery, Vejle Hospital, Vejle, Denmark

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Alma Bečić Pedersen Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark

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Ola Rolfson The Swedish Hip Arthroplasty Register
Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

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Cecilia Rogmark The Swedish Hip Arthroplasty Register
Lund University, Skåne University Hospital, Department of Orthopedics, Malmö, Sweden

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Ove Furnes The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
Department of Clinical Medicine, University of Bergen, Bergen, Norway

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Geir Hallan The Norwegian Arthroplasty Register, Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
Department of Clinical Medicine, University of Bergen, Bergen, Norway

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Keijo Mäkelä The Finnish Arthroplasty Register
Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland

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Richard de Steiger Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, Australia
Department of Surgery, Epworth HealthCare, University of Melbourne, Melbourne, Australia

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Martyn Porter The National Joint Registry of England, Wales, Northern Ireland and Isle of Man
Centre for Hip Surgery, Wrightington Hospital, Wrightington, Wigan and Leigh NHS Trust, Lancashire, United Kingdom

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Søren Overgaard The Danish Hip Arthroplasty Register
Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark

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Arthroplasty Register (DHR) was established in 1995. 38 , 39 Besides important monitoring in annual reports and specific studies on patient- and implant-related risk factors for adverse outcome, 40 - 42 other adverse outcomes including venous

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Claus Varnum The Danish Hip Arthroplasty Register
Department of Orthopaedic Surgery, Vejle Hospital, Vejle, Denmark

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Alma Bečić Pedersen Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark

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Per Hviid Gundtoft Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark

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Søren Overgaard The Danish Hip Arthroplasty Register
Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
Orthopaedic Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark

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population, making it possible to study rare interventions and rare outcomes at low cost and quickly. In addition, observational register studies are suitable for studying non-modifiable risk factors such as underlying hip disease, body mass index (BMI), age

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Peter Richard Almeida University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa

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Lipalo Mokete University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa

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Nkhodiseni Sikhauli University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa

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Ahmad Mota University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa

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Bayanda Ndindwa University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa

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Jurek R T Pietrzak University of the Witwatersrand, Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa

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( 5 ). This has necessitated an increased effort to prevent post-operative complications by identifying and addressing pre-operative modifiable risk factors ( 5 , 6 , 7 ). There has been a significant increase in publications regarding malnutrition

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Shaho Hasan Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands

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Peter van Schie Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands

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Bart L Kaptein Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands

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Jan W Schoones Walaeus Library, Leiden University Medical Centre, Leiden, The Netherlands

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Perla J Marang-van de Mheen Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands
Department of Safety & Security Science, Delft University of Technology, Delft, The Netherlands

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Rob G H H Nelissen Department of Orthopaedics, Leiden University Medical Centre, Leiden, The Netherlands

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Introduction Aseptic loosening is the leading cause for revision of total hip and total knee arthroplasties (THAs/TKAs) reported in national arthroplasty registries ( 1 , 2 ). Aseptic loosening may have a multitude of causes including factors

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