Diagnostic work-up strategy for periprosthetic joint infections after total hip and knee arthroplasty: a 12-year experience on 320 consecutive cases

Abstract

BackgroundElective knee and hip arthroplasty is followed by infections in currently about 0.5–2.0 % of cases – a figure which is on the increase due to the rise in primary implants. Correct diagnosis early on is essential so that appropriate therapy can be administered. This work presents a retrospective analysis of the diagnoses of patients suffering infections after total hip or knee arthroplasty.Methods320 patients with prosthetic joint infection (PJI) following knee or hip arthroplasty were identified. They comprised a) 172 patients with an infection after total hip arthroplasty (THA): 56 % females (n = 96) and 44 % males (n = 76) with a mean age of 70.9 (39–92) years; and 148 patients with an infection after total knee arthroplasty (TKA): 55 % females (n = 82) and 45 % males (n = 66) with a mean age of 70.7 (15–87) years.ResultsAlthough significantly more TKA than THA patients reported pain, erythema, a burning sensation and swelling, no differences between the two groups were observed with respect to dysfunction, fever or fatigue. However, significant differences were noted in the diagnosis of loosening (THA 55 %, TKA 31 %, p < 0.001) and suspected infection using conventional X-rays (THA 61 %, TKA 29 %, p < 0.001). FDG-PET-CT produced very good results in nearly 95 % of cases. There were no differences between THA and TKA patients regarding levels of inflammation markers. Histological evaluation proved to be significantly better than microbiological analysis.SummaryThe clinical picture may be non-specific and not show typical inflammatory symptoms for a long time, particularly in PJI of the hip. As imaging only provides reliable conclusions after the symptoms have persisted for a long time, morphological imaging is not suitable for the detection of early infections. FDG-PT-CT proved to be the most successful technique and is likely to be used more frequently in future. Nevertheless, there are currently no laboratory parameters which are suitable for the reliable primary diagnosis of PJI. Diagnosis requires arthrocentesis, and the fluid obtained should always be examined both microbiologically and histologically.

The combinations of multiple factors to improve the diagnostic sensitivity and specificity after artificial joint infection

“…12 An AL case after THA medium-quality diagnostic value. This result was resembled with several previous studies [9,10]. Some previous studies had mentioned that ESR and CRP were representative serologic values for diagnosing infection [11,12].…”

Rational and reliable diagnosis of periprosthetic hip and knee joint infection using two nuclear-medicine methods: 99mTc-ciprofloxacin and 99mTc-MDP scintigraphy

“…Nagoya et al 23 reported that the test was 88% sensitive and 90% specific for hip replacement infection. Many other authors, however, reported good sensitivity, unsatisfactory specificity, or both 4,10,24 . Since the MDP bone scintigraphy has a high NPV, normal results of study make very unlikely that the patient's symptoms are related to PJI 10,23,24 .…”

Biofilm formation in total hip arthroplasty: prevention and treatment

“…In 1969, John Charnley reported an infection rate of 9.5% following total hip arthroplasty (THA) 3 . In comparison, contemporary reports of infection in THA vary between 1 to 2% 4 . This large fall in the rate of infection is due to a number of factors: improved patient selection, laminar airflow operating rooms, protocols of perioperative antibiotic prophylaxis and an improved generic understanding of the importance of sterilisation 5 .…”

“…The aim of this review paper is to assess current knowledge on treatments, pathogenesis and prevention of infections associated with implants used in total hip arthroplasty. 4…”