Background The periprosthetic joint infection (PJI) is a severe complication in the field of arthroplasty. Despite the rising number of primary joint replacements, no unified therapeutic standard has been established for the treatment of PJI yet. Methods A survey on the principles of treatment of PJI in Germany was conducted. A total of 515 EndoProthetikZentren (EPZ) were included, resulting in a response rate of 100%. Results For early infections 97.6% of the centers use prosthesis-preserving procedures (DAIR). A one-stage exchange was implemented by less than 50% of the centers. If implemented, this treatment entails a prior selection of patients for a successful treatment. The two-stage exchange is performed in all centers, and most centers proceed with the implantation of a cemented spacer between stages. 75% of the centers proceed with a center-based concept for the treatment of PJI. Conclusion The aim of a uniform PJI standard at the centers has not yet been fully achieved. Further improvements within the certification were initiated. The most relevant treatment options in Germany are displayed. The two-stage revision with a cemented spacer is the most widely implemented treatment. This exposition of principles could help for the further development of standardized treatment guidelines and definitions.
Background There are different procedures for both, the diagnosis and the therapy of a periprosthetic joint infection (PJI), however, national or international guidelines for a standardised treatment regime are still lacking. The present paper evaluates the use of the predominant treatment protocols for PJI in certified total joint replacement centres (EPZ) in Germany based on an EndoCert questionnaire. Materials and methods The questionnaire was developed in cooperation with the EndoCert Certification Commission to survey the treatment protocols for septic revision arthroplasties in EPZ. Questions targeted the various treatment options including prosthesis preserving procedures (DAIR - Debridement, antibiotics, irrigation, and retention of the prosthesis), one-stage revision, two-stage revision, removal of the endoprosthesis and diagnostic sampling prior to re-implantation. All certified EPZ participated (n = 504) and the results from the current survey in 2020 were compared to data from a previous analysis in 2015. Results The number of centres that performed DAIR up to a maximum of 4 weeks and more than 10 weeks after index surgery decreased since 2015, while the number of centres that provided a one-stage revision as a treatment option increased (hip: + 6.3%; knee: + 6.6%). The majority of the centres (73.2%) indicated a 4–8 week period as the preferred interval between prosthesis removal and re-implantation in two-stage revision in hip as well as knee revisions. Centres with a higher number of revision surgeries (> 200 revisions/year), opted even more often for the 4–8 week period (92.3%). In two-stage revision the use of metal-based spacers with/without reinforcement with antibiotic-containing cement as an interim placeholder was significantly reduced in 2020 compared to 2015. There was also a clear preference for cemented anchoring in two-stage revision arthroplasty in the knee in 2020, whereas the majority of hip replacements was cementless. Additionally, in 2020 the number of samples for microbiological testing during the removal of the infected endoprosthesis increased and 72% of the centres took five or more samples. Overall, the number of EPZ with a standardised protocol for the procedure expanded from 2015 to 2020. Conclusion While there was a trend towards standardised therapeutic algorithms for PJI with more uniform choices among the centres in 2020 compared to 2015, the treatment often remains an individual decision. However, since a consistent treatment regime is of vital importance with an expected rise of total numbers of revision arthroplasties, uniform definitions with regard to comparability and standardisation are necessary for the further development of the EndoCert system.
Background: The PJI is a severe complication in the field of arthroplasty.Despite the rising number of primary joint replacements, no therapeutic standard has been established for the treatment of PJI yet.Methods: A survey on the principles of treatment of PJI in Germany wasconducted. A total of 515 EndoProthetikZentren were included, resulting in a response rate of 100%.Results: For early infections 97.6% of the centers use DAIR. A one-stage exchange was implemented by less than 50% of the centers. If implemented, this treatment entails a prior selection of patients for a successful treatment. The two-stage exchange is performed in all centers, and most centers proceed with the implantation of a cemented spacer between stages. 75% of the centers proceed with a center-based concept for the treatment of PJI.Conclusion: The rising number of primary joint replacements underlines the importance of developing standards and harmonized definitions for the treatment of PJI. These standards have not yet been fully achieved. The most relevant treatment options in Germany are displayed. The two-stage revision with a cemented spacer is the most widely implemented treatment option in Germany. This summary of principles could serve as a basis for the development of standardized treatment guidelines and definitions.
Background Since there are no national or international algorithms there are different procedures for both, the diagnosis and the therapy of a periprosthetic joint infection (PJI). Therefore, the present paper evaluates the respective protocols from different centres on the basis of an EndoCert questionnaire to treat PJI in certified total joint replacement centres (EPZ).Materials and methodsA questionnaire was developed in cooperation with the EndoCert Certification Commission to survey the principles to treat septic revision arthroplasties in EPZ including questions on various treatment options: prosthesis preserving procedures (DAIR - Debridement, antibiotics, irrigation, and retention of the prosthesis), one-stage revision, two-stage revision, removal of the endoprosthesis and sampling prior to reimplantation. All certified EPZ were included (n = 504). The results of the current survey 2020 were compared to those of a previous analysis.ResultsThe number of centres that performed DAIR up to a maximum of 4 weeks and more than 10 weeks after index surgery has clearly decreased since 2015, while the number of centres that provided a one-stage revision as a treatment option has increased (hip: +6.3%; knee: +6.6%). The majority of the centres (73.2%) indicated a 4-8 week period as the interval between prosthesis removal and reimplantation for two-stage replacement for both, hip and knee revisions. Amongst centres with a higher number of revision surgeries (>200 revisions/year), there were even more that opted for the 4-8 week period (92.3%). The Girdlestone situation, but also metal-based spacers with/without reinforcement with antibiotic-containing cement, are less frequently used. When exchanging knee replacements, there was a clear trend towards cemented anchoring, whereas cementless anchorage was preferred for hip replacements. Overall, the number of EPZ with a standardised protocol for the procedure continues to increase. In addition, more samples for microbiological testing are taken when removing the endoprosthesis, 72% of the centres take 5 or more samples.ConclusionWhile there was a trend towards standardised therapeutic algorithms for PJI with more uniform choices among the centres in 2020 compared to 2015, the treatment often remains an individual decision. However, since a consistent treatment regime is of vital importance with an expected rise of total numbers of revision arthroplasties, uniform definitions with regard to comparability and standardisation are necessary for the further development of the EndoCert system.
Background: The periprosthetic joint infection (PJI) is a severe complication in the field of arthroplasty. Despite the rising number of primary joint replacements, no unified therapeutic standard has been established for the treatment of PJI yet.Methods: A survey on the principles of treatment of PJI in Germany wasconducted. A total of 515 EndoProthetikZentren (EPZ) were included, resulting in a response rate of 100%.Results: For early infections 97.6% of the centers use prosthesis-preserving procedures (DAIR). A one-stage exchange was implemented by less than 50% of the centers. If implemented, this treatment entails a prior selection of patients for a successful treatment. The two-stage exchange is performed in all centers, and most centers proceed with the implantation of a cemented spacer between stages. 75% of the centers proceed with a center-based concept for the treatment of PJI.Conclusion: The aim of a uniform PJI standard at the centers has not yet been fully achieved. Further improvements within the certification were initiated. The most relevant treatment options in Germany are displayed. The two-stage revision with a cemented spacer is the most widely implemented treatment. This exposition of principles could help for the further development of standardized treatment guidelines and definitions.
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