New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society

Parvızı, Javad; Zmistowski, Benjamin; Berbari, Elie F.; Bauer, Thomas W.; Springer, Bryan D.; Valle, Craig J. Della; Garvin, Kevin L.; Mont, Michael A.; Wongworawat, Montri D.; Zalavras, Charalampos G.

doi:10.1007/s11999-011-2102-9

Cited by 1,584 publications

(1,142 citation statements)

References 16 publications

Supporting

Mentioning

1,093

Contrasting

Unclassified

Order By: Relevance

“…The four excluded patients included two lost to followup after prosthesis reimplantation (at 3 and 9 months with no known complications) and two who were deceased before 2 years (one before attempted prosthesis reimplantation and one 3 months after revision TKA). All patients met Musculoskeletal Infection Society criteria for periprosthetic joint infection [26], with the most common infecting organisms being Staphylococcal species (Table 1); eight patients had a polymicrobial infection and four were culture negative.…”

Section: Methodsmentioning

confidence: 99%

“…Data are presented as of the most recent [4], diabetes, smoking status, coronary artery disease, prior number of knee arthrotomies, prior extensor mechanism disruption, prior completed two-stage revision, skin defect size, surgical service performing flap (plastic surgery vs orthopaedics), knee procedure at the time of flap reconstruction, type of spacer used (articulating vs static) in patients who underwent resection TKA, and identity and antibiotic-resistance of infecting organism(s), were recorded. Patients were classified as having treatment failure if they experienced persistent or recurrent periprosthetic joint infection [26] and/or ultimately underwent reoperation, including removal of the prosthetic components, arthrodesis, or amputation. Individuals who retained their prosthesis without evidence of recurrent infection were classified as having a successful result.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

What Factors Influence the Success of Medial Gastrocnemius Flaps in the Treatment of Infected TKAs?

Tetreault

Valle

Bohl

et al. 2016

Clinical Orthopaedics &Amp; Related Research

Self Cite

View full text Add to dashboard Cite

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

What Factors Influence the Success of Medial Gastrocnemius Flaps in the Treatment of Infected TKAs?

Tetreault

Valle

Bohl

et al. 2016

Clinical Orthopaedics &Amp; Related Research

Self Cite

View full text Add to dashboard Cite

“…Two typical clinical conditions diagnosed as a superficial infection were cellulitis and infection confined to skin and subcutaneous tissue. Deep infection was defined according to the criteria of the Musculoskeletal Infection Society [19] and was managed by open débridement with insert change or two-staged exchange revision TKA. A surgical site infection, either superficial or deep, occurring within 1 year after TKA was considered to be positive for infectious complication.…”

Section: Methodsmentioning

confidence: 99%

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Hwang

Kim

Bamne

et al. 2015

Clinical Orthopaedics &Amp; Related Research

104

View full text Add to dashboard Cite

Background Patients with diabetes have increased risk of infections and wound complications after total knee arthroplasty (TKA). Glycemic markers identifying patients at risk for complications after TKA have not yet been elucidated. Questions/purposes We aimed to determine the correlations among four commonly used glycemic markers and to identify the glycemic markers most strongly associated with the occurrence of surgical site infections and postoperative wound complications in patients with diabetes mellitus after undergoing TKA. Methods Our retrospective study included 462 patients with diabetes, who underwent a total of 714 TKAs. Blood levels of glycemic markers, including preoperative fasting blood glucose (FBG), postprandial glucose (PPG2), glycated hemoglobin (HbA 1c ), and levels obtained from random glucose testing on postoperative days 2, 5, and 14, were collected on all patients as part of a medical clearance program and an established clinical pathway for patients with diabetes at our center. Complete followup was available on 93% (462 of 495) of the patients. Correlations among markers were assessed. Associations between the markers and patient development of complications were analyzed using multivariate regression analyses of relevant cutoff values. We considered any of the following as complications potentially related to diabetes, and these were considered study endpoints: surgical site infection (superficial and deep) and wound complications (drainage, hemarthrosis, skin necrosis, and dehiscence). During the period of study, there were no fixed criteria applied to what levels of glycemic control patients with diabetes needed to achieve before undergoing arthroplasty, and there were wide ranges in the levels of all glycemic markers; for example, whereas the mean HbA 1c level was 7%, the range was 5% to 11.3%.Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution has approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent was obtained. This work was performed at the Joint Reconstruction Center, Seoul National University Bundang Hospital, Seoul, Republic of Korea. Results There were positive correlations among the levels of the four glycemic markers; the strongest correlation was found between the preoperative HbA 1c and PPG2 levels (R = 0.502, p \ 0.001). After controlling for potential confounding variables using multivariate analysis, the HbA 1c cutoff level of 8 (odds ratio [OR], 6.1; 95% confidence interval...

show abstract

“…The presence of at least four of six minor criteria was also proposed to suggest PJI. The six minor criteria proposed were elevated ESR and CRP, elevated synovial white blood cell (WBC) count, increased synovial fluid polymorphonuclear cell percentage, isolation of a pathogen from one culture only, presence of purulence, and positive microscopy of the frozen section of periprosthetic tissue samples [30]. We do not routinely utilize frozen section of the periarticular tissues, thus eliminating one of the six minor criteria proposed by the MSIS.…”

Section: Methodsmentioning

confidence: 99%

“…Some authors have suggested different adjunctive criteria [5,27,36,38] to overcome shortcomings of bacteriologic culture, leading to discrepancy in their inclusion and exclusion criteria. To resolve this inconsistency, an expert panel from the Musculoskeletal Infection Society (MSIS) has reviewed existing evidence and published a set of diagnostic criteria for PJI [30]. This new definition integrates clinical, serologic, microbiologic, and histopathologic findings and joint aspirate analysis to distinguish between infected and aseptic failures.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Periprosthetic Joint Infection: The Threshold for Serological Markers

Alijanipour

Bakhshi

Parvızı

2013

Clinical Orthopaedics &Amp; Related Research

Self Cite

112

View full text Add to dashboard Cite

Background Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have recently been suggested as diagnostic criteria for periprosthetic joint infection (PJI) diagnosis. Thresholds for these markers should be reexamined since they have been determined arbitrarily. Questions/purposes Based on recently defined criteria for PJI, we determined (1) whether there is a difference in the threshold value of ESR and CRP between hips and knees, (2) whether the threshold value for ESR and CRP should be different for early-postoperative and late-chronic PJI, and (3) the optimal thresholds for ESR and CRP in PJI diagnosis. Methods We retrospectively reviewed 1962 patients with revision arthroplasty for aseptic failure (1095 hips, 594 knees) or first onset of PJI (108 hips, 165 knees) between 2000 and 2009. The PJI diagnosis was made independent of ESR and CRP using criteria recently proposed by the Musculoskeletal Infection Society. Patients with comorbidities that confound ESR and CRP were not included. Receiver operating characteristic (ROC) analysis was performed to determine thresholds. Results ESR and CRP levels in late-chronic PJI were higher in knees than in hips. Optimal thresholds for ESR and CRP were 48.5 mm/hour and 13.5 mg/L in hips and 46.5 mm/hour and 23.5 mg/L in knees, respectively. In early-postoperative PJI, ESR and CRP were similar in both joints with common thresholds of 54.5 mm/hour and 23.5 mg/L, respectively. Conclusions The data suggest a similar threshold for ESR but not for CRP should be implemented for late-chronic hips and knees. Optimal magnitudes are higher than conventional thresholds, indicating the need for refinement of thresholds if ESR and CRP are to be criteria for PJI diagnosis. Early-postoperative and late-chronic PJI might require different thresholds. Level of Evidence Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

show abstract

New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society

Cited by 1,584 publications

References 16 publications

What Factors Influence the Success of Medial Gastrocnemius Flaps in the Treatment of Infected TKAs?

What Factors Influence the Success of Medial Gastrocnemius Flaps in the Treatment of Infected TKAs?

Do Glycemic Markers Predict Occurrence of Complications After Total Knee Arthroplasty in Patients With Diabetes?

Diagnosis of Periprosthetic Joint Infection: The Threshold for Serological Markers

Contact Info

Product

Resources

About