Consensus document for the diagnosis of prosthetic joint infections: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement)

Abstract

Background For the diagnosis of prosthetic joint infection, real evidence-based guidelines to aid clinicians in choosing the most accurate diagnostic strategy are lacking. Aim and Methods To address this need, we performed a multidisciplinary systematic review of relevant nuclear medicine, radiological, orthopaedic, infectious, and microbiological literature to define the diagnostic accuracy of each diagnostic technique and to address and provide evidence-based answers on uniform statements for each topic that was found to be important to develop a commonly agreed upon diagnostic flowchart. Results and Conclusion The approach used to prepare this set of multidisciplinary guidelines was to define statements of interest and follow the procedure indicated by the Oxford Centre for Evidence-based Medicine (OCEBM). Electronic supplementary material The online version of this article (10.1007/s00259-019-4263-9) contains supplementary material, which is available to authorized users.

Assessment of a Multiplex Serological Test for the Diagnosis of Prosthetic Joint Infection: a Prospective Multicentre Study

“…Patients were distributed evenly between PJI and mechanical problems. All PJIs were chronic, with the presence of a sinus tract in a third of cases and a significantly increased CRP level, which reinforces the importance of measuring CRP in the diagnosis of PJI [7][8][9][10].…”

“…According to the IDSA, International Consensus on Orthopaedic Infections and European Bone and Joint Infection Society guidelines, definitive evidence of PJI is a sinus tract in communication with the prosthesis and/or 2 or more perioperative cultures or a combination of preoperative and perioperative cultures that yield the same organism [2,4,5,7].…”

“…The clinical Ivyspring International Publisher signs are non-specific when they include pain and inflammation in the absence of fever. The cornerstone for the diagnosis remains bacteriological culture of pre-and/or perioperative samples, which is considered as a major criterion by the Infectious Diseases Society of America (IDSA), the International Consensus on Orthopaedic Infections, and other European learned societies [4][5][6][7][8].…”

18F-FDG PET for Diagnosing Infections in Prosthetic Joints

“…14 Also, there currently are no published evidence-based guidelines to guide the diagnostic work-up of PJI. 14 Table 2 provides a global, descriptive overview of the accuracy of different imaging modalities.…”

MRI as Diagnostic Modality for Analyzing the Problematic Knee Arthroplasty: A Systematic Review

“…To differentiate among the potential causative factor(s), various imaging techniques are available after the basic workup, which involves extensive history, physical examination, radiographs (including long leg view), and lab tests. The imaging techniques utilized include combinations of radiographic views, stress radiographs, computed tomography (CT), magnetic resonance imaging (MRI), planar bone scintigraphy with or without single photon emission computed tomography (SPECT), and fluorodeoxyglucose (FDG)‐positron emission tomography (PET)/CT . It would be valuable if one imaging technique could offer the same diagnostic power as two or more other imaging techniques for identifying the cause(s) of failure.…”