Evaluation of The Standard Procedure for the Treatment of Periprosthetic Joint Infections (PJI) in Germany - Results of a Survey within the EndoCert Initiative

Abstract

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.

Recent trends in revision knee arthroplasty in Germany

“…Since our analysis allows not to distinguish between acute and chronic PJIs as rTKA reasons, a steady state in DAIR procedures would suggest chronic PJIs having increased over time or DAIR experienced less acceptance by the treating surgeons. A survey of 515 centers for primary and revision arthroplasty, however, revealed that DAIR is an established treatment alternative in 97.6% of the centers 20 . Thus, limited acceptance to DAIR might be due to factors associated with DAIR failure.…”