Development and Validation of an Evidence-Based Algorithm for Diagnosing Periprosthetic Joint Infection

Shohat, Noam; Tan, Timothy L.; Valle, Craig J. Della; Calkins, Tyler E.; George, Jaiben; Higuera, Carlos A.; Parvızı, Javad

doi:10.1016/j.arth.2019.06.016

Cited by 45 publications

(23 citation statements)

References 20 publications

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“…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].…”

Section: Discussionsupporting

confidence: 56%

“…The alpha-defensin quick on-table lateral flow test (Synovasure, Zimmer Biomet, USA), proposing maximum specificity in a short time, has even been proposed as a perioperative confirmatory test for PJI [17]. However, some other studies should moderate the recent enthusiasm for these biomarkers, now considered as minor diagnostic criteria for PJI [6,8]. Kleist et al [18] recently showed that the performances of the synovial fluid alpha-defensin ELISA are insufficient to accurately diagnose PJI, especially due to coagulasenegative staphylococci [18].…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Bémer¹,

Bourigault

Jolivet‐Gougeon

et al. 2020

J. Bone Joint Infect.

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Introduction:The diagnosis of prosthetic joint infections (PJIs) can be difficult in the chronic stage and is based on clinical and paraclinical evidence. A minimally invasive serological test against the main pathogens encountered during PJI would distinguish PJI from mechanical loosening. Methods: We performed a prospective, multicentre, cross-sectional study to assess the contribution of serology in the diagnosis of PJI. Over a 2-year period, all patients undergoing prosthesis revision were included in the study. A C-reactive protein assay and a serological test specifically designed against 5 bacterial species (Staphylococcus aureus, S. epidermidis, S. lugdunensis, Streptococcus agalactiae, Cutibacterium acnes) were performed preoperatively. Five samples per patient were taken intraoperatively during surgery. The diagnosis of PJI was based on clinical and bacteriological criteria according to guidelines. Results: Between November 2015 and November 2017, 115 patients were included, 49 for a chronic PJI and 66 for a mechanical problem. Among patients with PJI, a sinus tract was observed in 32.6% and a C-reactive protein level ≥10 mg/L in 74.5%. The PJI was monomicrobial in 43 cases (targeted staphylococci, 24; S. agalactiae, 1; C. acnes, 2; others, 16), and polymicrobial in 6 cases (12.2%). Sensitivity, specificity, positive predictive value and negative predictive value were 75.0%, 82.1%, 58.3% and 90.8%, respectively, for targeted staphylococci. Specificity/negative predictive value was 97.3%/100% for S. agalactiae and 83.8% /96.9% for C. acnes. Conclusions: The serological tests are insufficient to affirm the diagnosis of PJI for the targeted bacteria. Nevertheless, the excellent NPV may help clinicians to exclude PJI.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Bémer¹,

Bourigault

Jolivet‐Gougeon

et al. 2020

J. Bone Joint Infect.

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“…En caso de no tener ninguna evidencia aparente de infección, como protocolo diagnóstico se debe solicitar la velocidad sedimentación globular y proteína C reactiva. 10,16 Ninguno de estos dos reactantes fase aguda es específico para diagnóstico de infección; sin embargo, su sensibilidad sí es alta (de 90 a 95%), por lo que niveles normales de ambos pueden descartar infección. En caso de niveles anor-www.medigraphic.org.mx malmente elevados nos obliga a realizar aspiración de líquido sinovial y punción de la articulación.…”

Section: Diagnóstico En Osteólisis De Atcunclassified

Aflojamiento aséptico en la prótesis total de cadera

Parra¹

2019

Ortho-Tips

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“…The D-dimer test is a component of the proposed modified scoring criteria for diagnosis of periprosthetic joint infection (PJI) [ 4 ]. Some authors claim that newer markers for PJIs have not been sufficiently studied, despite prior claims of sufficient data to include them in the scoring-based definition [ 5 ]. The lack of standardization of this test among laboratories leads to significant variability in results, which will impact the external validity of the proposed PJI criteria across institutions [ [1] , [2] , [3] ].…”

Section: Introductionmentioning

confidence: 99%

D-Dimer Varies Widely Across Instrument Platforms and is Not a Reliable Indicator of Periprosthetic Joint Infections

2020

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The D-dimer test is a component of the modified scoring criteria for periprosthetic joint infection (PJI). The performance of the D-dimer test varies greatly among laboratories because of the lack of standardization. Laboratories may use different assays and will produce widely varying results for the same sample. This study used published proficiency testing data from 3903 laboratories to demonstrate the variability in D-dimer results and estimate the misclassification rate of patients using the proposed cutoff for the test as a component of PJI criteria. Given the variability in D-dimer results, a clinically significant percentage of patients are likely to be misclassified. The data illustrate that a universal cutoff for this marker in the context of assessment for PJI is not appropriate. Each site must conduct a study to determine an appropriate cutoff for their unique testing platform.

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Development and Validation of an Evidence-Based Algorithm for Diagnosing Periprosthetic Joint Infection

Cited by 45 publications

References 20 publications

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

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

Aflojamiento aséptico en la prótesis total de cadera

D-Dimer Varies Widely Across Instrument Platforms and is Not a Reliable Indicator of Periprosthetic Joint Infections

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