Evolution of Diagnostic Definitions for Periprosthetic Joint Infection in Total Hip and Knee Arthroplasty

Villa, Jesus M.; Pannu, Tejbir S.; Piuzzi, Nicolás S.; Riesgo, Aldo M.

doi:10.1016/j.arth.2019.10.032

Cited by 28 publications

(27 citation statements)

References 22 publications

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“…The definition criteria of PJI remain among the most controversial aspects in PJI treatment [57]. None of the existing definition criteria is uniformly accepted, but may largely influence the clinical course of the patients as well as the outcomes reported in literature.…”

Section: Discussionmentioning

confidence: 99%

Two-Stage Revision Total Hip Arthroplasty Without Spacer Placement: A Viable Option to Manage Infection in Patients With Severe Bone Loss or Abductor Deficiency

Hipfl

Carganico

Leopold

et al. 2021

The Journal of Arthroplasty

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Background: High rates of spacer-related complications in two-stage exchange total hip arthroplasty (THA) have been reported. Patients with advanced bone defects and abductor deficiency may benefit from a nonspacer two-stage revision. This study reports on the clinical course of a contemporary twostage exchange for periprosthetic hip infection without spacer insertion. Methods: We reviewed 141 infected THAs with extensive bone loss or abductor damage who underwent two-stage exchange without spacer placement. The mean duration from resection arthroplasty to reimplantation was 9 weeks (2-29). Clinical outcomes included interim revision, reinfection, and aseptic revision rates. Restoration of leg-length and offset was assessed radiographically. Modified Harris hip scores were calculated. Mean follow-up was 5 years (3-7). Treatment success was defined using the modified Delphi consensus criteria. Results: Thirty-four patients (24%) had treatment failure, including 13 reinfections, 16 interim redebridements for persistent infection, 2 antibiotic suppressive therapies, and 3 prosthetic joint infection erelated deaths. Aseptic rerevision after reimplantation was necessary in 14 patients (10%). Dislocation accounted for most aseptic complications, with 20 dislocations occurring in 15 patients (11%). Leglength and offset were restored to preoperative measures. Mean modified Harris hip scores significantly improved from 35 points to 67 points. Conclusion: A nonspacer two-stage exchange is a viable option for managing chronically infected THA with severe bone loss or abductor deficiency, showing comparable rates of interim revision and recurrence of infection. Cementless reimplantation demonstrates good midterm survivorship with comparable functional outcomes and leg-length restoration. However, dislocation continues to be a major concern.

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Section: Discussionmentioning

confidence: 99%

Two-Stage Revision Total Hip Arthroplasty Without Spacer Placement: A Viable Option to Manage Infection in Patients With Severe Bone Loss or Abductor Deficiency

Hipfl

Carganico

Leopold

et al. 2021

The Journal of Arthroplasty

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“…Diagnostic definitions of PJI has continuously evolved in the last decade [ 19 ]. However, with the exception of the latest Musculoskeletal Infection Society (MSIS) criteria [ 7 ] none of the current PJI definitions have been validated in clinical trials.…”

Section: Discussionmentioning

confidence: 99%

The W.A.I.O.T. Definition of Peri-Prosthetic Joint Infection: A Multi-center, Retrospective Validation Study

Божкова

Suardi

Sharma

et al. 2020

JCM

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Peri-prosthetic joint infection (PJI) definition plays an important role in diagnostic and therapeutic decisions. However, while several criteria have been proposed by eminent institutions to define a PJI in the last decade, their clinical validation has been rarely performed. Aim of the present multicenter, international, retrospective study was to validate the World Association against Infection in Orthopedics and Trauma (WAIOT) pre/intra-operative PJI definition with post-operative confirmatory tests. A total of 210 patients, undergoing hip (n = 86) or knee (n = 124) revision surgery for any reason in six orthopedic centers in Africa, Asia, Europe and South America, were retrospectively evaluated at a two years minimum follow-up after surgery. All the available pre-, intra- and post-operative findings were collected and analyzed according to the WAIOT criteria, which include a set of tests to confirm (Rule In) or to exclude (Rule Out) a PJI. On average, patients were investigated pre/intra-operatively with 3.1 ± 1.1 rule out and 2.7 ± 0.9 rule in tests; the presence of a fistula or exposed implant was reported in 37 patients (17.6%). According to pre/intraoperative findings, 36.2% of the patients were defined as affected by high-grade PJI (n = 76; average score: 2.3 ± 0.8), 21.9% by low-grade PJI (n = 46; average score: 0.8 ± 0.8), 10.5% by biofilm-related implant malfunction (n = 22; average score: –1.6 ± 0.8), 2.9% as contamination (n = 6; average score: –3.5 ± 1.0), and 28.6% as no infection (n = 60; average score: –3.0 ± 1.4). Pre/intra-operative PJI definitions matched post-operative confirmatory tests, in 97.1% of the patients. This is, to our knowledge, one of the largest study ever conducted to validate a PJI definition The retrospective analysis in different centers was greatly facilitated by the structure of the WAIOT definition, that allows to include different tests on the basis of their sensitivity/specificity, while the comparison between pre/intra-operative and post-operative findings offered the internal validation of the scoring system. Our results authenticate the WAIOT definition as a reliable, simple tool to identify patients affected by PJI prior to joint revision surgery.

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“…A “gold standard” definition remains elusive for chronic PJI. 33 In this review, we follow the 2013 ICM definition for PJI, this is summarized in Table 1 . 33 Chronic PJI is defined as an infection present for 4 weeks or longer, thus potentially involving a mature biofilm.…”

Section: Methodsmentioning

confidence: 99%

“…(2) Values provided are for the diagnosis of chronic PJI rather than acute. Source: Adapted from Villa et al 2020 33.…”

mentioning

confidence: 99%

An Australian Algorithm to Guide the Surgical Management of Chronic Prosthetic Joint Infection: A Multi-Disciplinary Team Approach

Jiang

Sires

Daniel

et al. 2022

The Journal of Hip Surgery

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Chronic prosthetic joint infection (PJI) is a leading cause of failure for total joint arthroplasty. Historically, two-stage revision arthroplasty has been considered the gold standard approach to chronic PJI, however, emerging evidence suggests that one-stage revision arthroplasty may be underutilized. To our knowledge, there have been no previously published guidelines for the surgical management of chronic PJI in Australia, resulting in significant heterogeneity in management within and across centers. We aim to review contemporary concepts in the surgical management of PJI and develop an evidence-based algorithm to optimize the management of chronic hip and knee PJI, incorporating a multidisciplinary team (MDT) approach. A review was conducted to identify existing articles discussing surgical management of chronic PJI, specifically contraindications to one-stage revision arthroplasty. Absolute contraindications for one-stage revision include difficulty in treating organisms, significant soft tissue compromise, and concurrent sepsis. Relative contraindications include lack of preoperative identification of organism, presence of a sinus tract, fungal infections, significant bone loss, and immunocompromise. In determining the management of patients with a relative contraindication, MDT discussion with the consideration of patient's overall local, host, and microbiological profile is necessary. Using gathered evidence, absolute and relative contraindications for one-stage revision arthroplasty were developed into an algorithm. The algorithm is designed to assist our PJI MDT in making optimized decisions when choosing between a one-stage versus two-stage approach. Ongoing follow-up is underway to determine the effect of implementing this algorithm on patient outcomes, eradication rates, and revision rates within our center.

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Evolution of Diagnostic Definitions for Periprosthetic Joint Infection in Total Hip and Knee Arthroplasty

Cited by 28 publications

References 22 publications

Two-Stage Revision Total Hip Arthroplasty Without Spacer Placement: A Viable Option to Manage Infection in Patients With Severe Bone Loss or Abductor Deficiency

Two-Stage Revision Total Hip Arthroplasty Without Spacer Placement: A Viable Option to Manage Infection in Patients With Severe Bone Loss or Abductor Deficiency

The W.A.I.O.T. Definition of Peri-Prosthetic Joint Infection: A Multi-center, Retrospective Validation Study

An Australian Algorithm to Guide the Surgical Management of Chronic Prosthetic Joint Infection: A Multi-Disciplinary Team Approach

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