Methodological Challenges in Predicting Periprosthetic Joint Infection Treatment Outcomes: A Narrative Review

Abstract

The management of periprosthetic joint infection (PJI) generally requires both surgical intervention and targeted antimicrobial therapy. Decisions regarding surgical management–whether it be irrigation and debridement, one-stage revision, or two-stage revision–must take into consideration an array of factors. These include the timing and duration of symptoms, clinical characteristics of the patient, and antimicrobial susceptibilities of the microorganism(s) involved. Moreover, decisions relating to surgical management must consider clinical factors associated with the health of the patient, alongside the patient's preferences. These decisions are further complicated by concerns beyond mere eradication of the infection, such as the level of improvement in quality of life related to management strategies. To better understand the probability of successful surgical treatment of a PJI, several predictive tools have been developed over the past decade. This narrative review provides an overview of available clinical prediction models that aim to guide treatment decisions for patients with periprosthetic joint infection, and highlights key challenges to reliably implementing these tools in clinical practice.

Acute Haematogenous Revision Total Knee Arthroplasty Infection by Streptococcus canis Treated by Debridement, Antibiotics, and Implant Retention: A Case Report

“…PJIs are one of the most feared and serious complications for orthopaedic surgeons [ 2 , 3 ] due to the associated morbidities [ 1 , 4 ] as well as the non-negligible risk of mortality [ 1 , 4 ], their incidence being up to 5-6% in revision TKA [ 5 ]. Tsukayama et al [ 6 ] classified PJI into four types: immediate post-surgery, chronic, haematogenous, and positive intraoperative cultures.…”

“…The incidence of primary prosthetic knee infections ranges between 1% and 2% but increases up to 5-6% in revision surgeries [ 5 ]. Prosthetic infections are typically classified according to the Tsukayama classification into four types: immediate post-surgery, chronic, haematogenous, and positive intraoperative cultures [ 6 ].…”

Validation of a Classification System for Optimal Application of Debridement, Antibiotics, and Implant Retention in Prosthetic Joint Infections following Total Knee Arthroplasty: A Retrospective Review

“…The KLIC score was predictive of failure in early PJI and the CRIME-80 score was predictive of failure for hematogenous infections [8,16,17,19]. On external validation, the KLIC score was shown to have an area under the receiver-operating curve (AUC) to be 0.64 (0.839 internal validation), and the CRIME-80 was shown to have an AUC of 0.61 leaving room for improvement and adaptations to these scoring systems to predict a successful DAIR [16,17,[20][21][22][23].…”