Title : Prevalence and risk factors of surgical site infections following Total Knee Replacement (TKR) in Saudi Arabia: A systematic review and meta-analysis
Abstract:
Introduction: Total Knee Replacement (TKR) is a common procedure intended to restore mobility and alleviate arthritis-related pain. Surgical site infection (SSI) occurs in 1–3% of cases globally and can lead to prosthesis failure, extended hospital stays, and increased morbidity. Risk factors for SSI include comorbidities such as obesity and diabetes, prolonged surgery, and antibiotic protocols. While global data on SSI are available, studies specific to Saudi Arabia are limited. This review assesses SSI prevalence, risk factors, and antibiotic prophylaxis efficacy in Saudi TKR patients.
Methods: Following PRISMA guidelines, this review was registered with PROSPERO. Databases—including Medline, Google Scholar, CENTRAL, and Web of Science—were searched from their inception to February 2024. Studies that involved Saudi adults (≥18 years) undergoing TKR and reported SSI prevalence and risk factors were included in the review. Data extraction and evaluation were performed independently by two reviewers using the Newcastle-Ottawa Scale. Meta-analyses were conducted with R software.
Results: A total of twelve studies involving 5,317 patients were analyzed. The pooled SSI rate was 2% (95% CI: 1–3%) with moderate heterogeneity (I² = 64.3%). Superficial and deep infections each accounted for 1% of the total (95% CI: 0–1%). Risk factors for SSI included obesity, and prolonged surgical duration. Antibiotics such as vancomycin and cefazolin demonstrated varying efficacy, and Staphylococcus aureus was the most commonly reported pathogen.
Conclusion: SSIs pose a significant concern for Saudi TKR patients, especially those with comorbidities. The 2% SSI rate observed in this review is aligned with the global average, reflecting comparable healthcare standards. Enhanced perioperative care and optimized antibiotic protocols are essential to reduce SSI rates, and further research is warranted to improve prevention strategies.
