[Diagnosis of Periprosthetic Joint Infection : Development of an Evidence-based Algorithm by the Work Group of Implant-associated Infection of the AE-(German Society for Arthroplasty)]

Overview

Journal Orthopade

Specialty Orthopedics

Date 2020 Jul 16

PMID 32666142

Citations 16

Authors

H Muhlhofer

N Renz

A Zahar

M Ludemann

M Rudert

R Hube

L Frommelt

R Ascherl

C Perka

R von Eisenhart-Rothe

Affiliations

Soon will be listed here.

Abstract

Background: Prosthetic joint infections (PPI) will challenge orthopaedic surgeons and the health care system in the coming years. Evidence-based and reliable preoperative diagnostics are necessary for success in the field of revision arthroplasty. Especially the preoperative detection of PPI is important with respect to the treatment strategy.

Aim: The aim of this study was to develop a detailed and structured standard operating procedure (SOP) to detect PPI preoperatively.

Methods: A systematic literature research was performed and relevant articles identified. After extracting the data, statistical calculations of sensitivity, specificity, positive/negative predictive value and positive/negative likelihood ratio were performed. The results were discussed and evaluated in four meetings analogously to standard Delphi rounds by the workgroup of implant-associated infections of the German AE (Arbeitsgemeinschaft Endoprothetik). An algorithm for the diagnostic approach according to ISO 5807 was made.

Results: The standardized algorithm combines a sequence of evidence-based procedures with detailed and structured main and additional criteria to every critical step in the diagnostic approach.

Conclusion: The detection of PPI is of tremendous importance prior to revision arthroplasty and determines its success or failure. The diagnosis "prosthetic joint infection" requires a substantial change with respect to treatment concepts. The algorithm summarizes current literature and specialized expert opinions in a modern standardized format for a transparent diagnostic approach.

Citing Articles

[Arthroplasty and oral health-an overview].

Pempe C, Schmalz G, Ziebolz D, Roth A Orthopadie (Heidelb). 2024; 53(10):782-788.

PMID: 39138653 DOI: 10.1007/s00132-024-04550-2.

Results of a monocentric field study: value of histology compared to sonication method and conventional tissue culture in the diagnosis of periprosthetic joint infection (PJI).

Rohrl A, Klawonn F, Fuchtmeier B, Wulbrand C, Gessner A, Zustin J Infection. 2024; 52(6):2287-2296.

PMID: 38730201 DOI: 10.1007/s15010-024-02278-x.

Diagnostics in Late Periprosthetic Infections-Challenges and Solutions.

Sax F, Hoyka M, Blersch B, Fink B Antibiotics (Basel). 2024; 13(4).

PMID: 38667027 PMC: 11047502. DOI: 10.3390/antibiotics13040351.

Rescuing Infected Deep Brain Stimulation Therapies in Severely Affected Patients.

Fortmann T, Zawy Alsofy S, Lewitz M, Santacroce A, Welzel Saravia H, Sakellaropoulou I Brain Sci. 2023; 13(12).

PMID: 38137098 PMC: 10742038. DOI: 10.3390/brainsci13121650.

[Structured approach for infected prosthesis].

Scharf M, Schraag A, Ehrnsperger M, Grifka J Z Rheumatol. 2023; 82(10):859-866.

PMID: 37851164 DOI: 10.1007/s00393-023-01421-7.

References

Ali F, Wilkinson J, Cooper J, Kerry R, Hamer A, Norman P . Accuracy of joint aspiration for the preoperative diagnosis of infection in total hip arthroplasty. J Arthroplasty. 2006; 21(2):221-6. DOI: 10.1016/j.arth.2005.05.027. View

Mulcahy D, Fenelon G, McInerney D . Aspiration arthrography of the hip joint. Its uses and limitations in revision hip surgery. J Arthroplasty. 1996; 11(1):64-8. DOI: 10.1016/s0883-5403(96)80162-8. View

Kasparek M, Kasparek M, Boettner F, Faschingbauer M, Hahne J, Dominkus M . Intraoperative Diagnosis of Periprosthetic Joint Infection Using a Novel Alpha-Defensin Lateral Flow Assay. J Arthroplasty. 2016; 31(12):2871-2874. DOI: 10.1016/j.arth.2016.05.033. View

Virolainen P, Lahteenmaki H, Hiltunen A, Sipola E, Meurman O, Nelimarkka O . The reliability of diagnosis of infection during revision arthroplasties. Scand J Surg. 2002; 91(2):178-81. DOI: 10.1177/145749690209100208. View

Zmistowski B, Karam J, Durinka J, Casper D, Parvizi J . Periprosthetic joint infection increases the risk of one-year mortality. J Bone Joint Surg Am. 2013; 95(24):2177-84. DOI: 10.2106/JBJS.L.00789. View

Berbari E, Hanssen A, Duffy M, Steckelberg J, Ilstrup D, Harmsen W . Risk factors for prosthetic joint infection: case-control study. Clin Infect Dis. 1998; 27(5):1247-54. DOI: 10.1086/514991. View

Pohlig F, Muhlhofer H, Lenze U, Lenze F, Suren C, Harrasser N . Diagnostic accuracy of arthroscopic biopsy in periprosthetic infections of the hip. Eur J Med Res. 2017; 22(1):6. PMC: 5336685. DOI: 10.1186/s40001-017-0246-0. View

Teller R, Christie M, Martin W, Nance E, Haas D . Sequential indium-labeled leukocyte and bone scans to diagnose prosthetic joint infection. Clin Orthop Relat Res. 2000; (373):241-7. DOI: 10.1097/00003086-200004000-00029. View

Pulido L, Ghanem E, Joshi A, Purtill J, Parvizi J . Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res. 2008; 466(7):1710-5. PMC: 2505241. DOI: 10.1007/s11999-008-0209-4. View

10.

Schafer P, Fink B, Sandow D, Margull A, Berger I, Frommelt L . Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis. 2008; 47(11):1403-9. DOI: 10.1086/592973. View

11.

Uckay I, Lubbeke A, Emonet S, Tovmirzaeva L, Stern R, Ferry T . Low incidence of haematogenous seeding to total hip and knee prostheses in patients with remote infections. J Infect. 2009; 59(5):337-45. DOI: 10.1016/j.jinf.2009.08.015. View

12.

Kamme C, Lindberg L . Aerobic and anaerobic bacteria in deep infections after total hip arthroplasty: differential diagnosis between infectious and non-infectious loosening. Clin Orthop Relat Res. 1981; (154):201-7. View

13.

Guyatt G, Oxman A, Kunz R, Atkins D, Brozek J, Vist G . GRADE guidelines: 2. Framing the question and deciding on important outcomes. J Clin Epidemiol. 2011; 64(4):395-400. DOI: 10.1016/j.jclinepi.2010.09.012. View

14.

Zmistowski B, Restrepo C, Huang R, Hozack W, Parvizi J . Periprosthetic joint infection diagnosis: a complete understanding of white blood cell count and differential. J Arthroplasty. 2012; 27(9):1589-93. DOI: 10.1016/j.arth.2012.03.059. View

15.

Zimmerli W, Trampuz A, Ochsner P . Prosthetic-joint infections. N Engl J Med. 2004; 351(16):1645-54. DOI: 10.1056/NEJMra040181. View

16.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7):e1000097. PMC: 2707599. DOI: 10.1371/journal.pmed.1000097. View

17.

Greidanus N, Masri B, Garbuz D, Wilson S, McAlinden M, Xu M . Use of erythrocyte sedimentation rate and C-reactive protein level to diagnose infection before revision total knee arthroplasty. A prospective evaluation. J Bone Joint Surg Am. 2007; 89(7):1409-16. DOI: 10.2106/JBJS.D.02602. View

18.

Peel T, Dowsey M, Daffy J, Stanley P, Choong P, Buising K . Risk factors for prosthetic hip and knee infections according to arthroplasty site. J Hosp Infect. 2011; 79(2):129-33. DOI: 10.1016/j.jhin.2011.06.001. View

19.

Atkins B, Athanasou N, Deeks J, Crook D, Simpson H, Peto T . Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty. The OSIRIS Collaborative Study Group. J Clin Microbiol. 1998; 36(10):2932-9. PMC: 105090. DOI: 10.1128/JCM.36.10.2932-2939.1998. View

20.

Della Valle C, Sporer S, Jacobs J, Berger R, Rosenberg A, Paprosky W . Preoperative testing for sepsis before revision total knee arthroplasty. J Arthroplasty. 2007; 22(6 Suppl 2):90-3. DOI: 10.1016/j.arth.2007.04.013. View