Success After Treatment of Periprosthetic Joint Infection: A Delphi-based International Multidisciplinary Consensus

Díaz-Ledezma, Claudio; Higuera, Carlos A.; Parvızı, Javad

doi:10.1007/s11999-013-2866-1

Cited by 293 publications

(206 citation statements)

References 39 publications

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“…We calculated sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios for each cytokine and MSIS criterion measured against successful or failed treatment at 1 year as the reference standard as described by Diaz-Ledezma et al [8]. If a cytokine level was below the inferior detection limit for the assay, the lowest reportable value was used.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment success or failure after a minimum of 1-year followup was the reference standard for the reimplantation group. Treatment failure was determined as described by Diaz-Ledezma et al [8] as (1) subsequent surgical intervention for infection after the index procedure (ie, second-stage reimplantation); (2) persistent fistula, drainage, or joint pain at last followup; and (3) occurrence of PJI-related mortality. Any unresolved drainage at the last followup visit was considered a failure.…”

Section: Methodsmentioning

confidence: 99%

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Synovial Cytokines and the MSIS Criteria Are Not Useful for Determining Infection Resolution After Periprosthetic Joint Infection Explantation

Frangiamore

Siqueira

Saleh

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Diagnosing periprosthetic joint infection (PJI) requires a combination of clinical and laboratory parameters, which may be expensive and difficult to interpret. Synovial fluid cytokines have been shown to accurately differentiate septic from aseptic failed total knee (TKA) and hip (THA) arthroplasties. However, after firststage explantation, there is still no reliable test to rule out PJI before a second-stage reimplantation procedure. Questions/purposes (1) Which synovial fluid cytokines have the highest diagnostic accuracy for PJI? (2) Which cytokine shows the greatest decrease associated with the resolution of infection in the same patient between explantation and subsequent reimplantation of an infected arthroplasty? (3) What is the accuracy of synovial fluid cytokines and the Musculoskeletal Infection Society (MSIS) criteria to rule out PJI after first-stage explantation? (4) What are the most studied synovial fluid cytokines for diagnosing PJI as reported in the literature and what are their cumulative diagnostic accuracy? Methods Between May 2013 and March 2014, 104 patients with painful THA and TKA evaluated for possible PJI were included in our study. Of these, 90 (87%) had cytokine levels measured from synovial fluid samples collected as part of this prospective study (n = 33 hips, n = 57 knees). A second group of 35 patients (n = 36 samples) who presented during the same time period with an antibiotic spacer also had synovial cytokines measured before second-stage reimplantation. For the first group of 90 patients, the MSIS definition classified each joint at the time of surgery as infected (n = 31) or not infected (n = 59) and was used as the standard to test the accuracy in diagnosing PJI. Of the 35 patients with synovial marker data before second-stage surgery, 15 patients had cytokine measurements both at explantation and reimplantation and were used to quantify the change between stages. The reimplantation group had a minimum 1-year followup (with four [11%] patients lost to followup) and was classified into successful or failed treatment based on DelphiOne of the authors certifies that he (CAH), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 from Stryker (Kalamazoo, MI, USA), an amount of USD 100,001 to USD 1,000,000 from KCI (San Antonio, TX, USA), an amount of USD 100,001 to USD 1,000,000 from Myoscience (Fresno, CA, USA), and an amount of USD 100,001 to USD 1,000,000 from CD Diagnostics (Claymont, DE, USA). One of the authors certifies that he (WKB), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 100,001 to USD 1,000,000 from Stryker, an amount of USD 100,000 to USD 1,000,000 from Exatech (Gainesville, FL, USA), an amount of USD 10,000 to USD 100,000 from Custom Orthopaedic Solutions (Cleveland, OH, USA), and an amount of USD 10,000 to USD 100,000 from KEF Healthcare (Dubai, UAE). All ICMJE Conflict of Intere...

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Synovial Cytokines and the MSIS Criteria Are Not Useful for Determining Infection Resolution After Periprosthetic Joint Infection Explantation

Frangiamore

Siqueira

Saleh

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…This highlights the importance of continuing to develop diagnostic strategies for this group of patients, in whom failures can be limb-threatening. We used Delphi criteria, which comprise a multitude of factors along with aborted reimplantation to define failure, whereas most other studies have considered failure as a requirement of subsequent surgery [11,26]. The reported rate of reinfection varies from 10% to 25% for the knees [12,14,17,23] and is slightly lower for the hips at 7% to 12% [6,13,16,29].…”

Section: Discussionmentioning

confidence: 99%

“…A treatment failure was defined as a case in which reimplantation was aborted as a result of clinical, laboratory, or histological parameters indicating infection or a case that failed the reimplantation. The failure of reimplantation was defined using the criteria published after a Delphi based consensus [11]. Successful reimplantation was defined as (1) control of infection, as characterized by a healed wound without fistula, drainage, or pain and no infection recurrence caused by the same organism strain; (2) no subsequent surgical intervention for infection after reimplantation surgery; and (3) no occurrence of PJI-related mortality (by causes such as sepsis or necrotizing fasciitis).…”

Section: Methodsmentioning

confidence: 99%

Are Frozen Sections and MSIS Criteria Reliable at the Time of Reimplantation of Two-stage Revision Arthroplasty?

George

Kwiecień

Klika

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Frozen section histology is widely used to aid in the diagnosis of periprosthetic joint infection at the second stage of revision arthroplasty, although there are limited data regarding its utility. Moreover, there is no definitive method to assess control of infection at the time of reimplantation. Because failure of a two-stage revision can have serious consequences, it is important to identify the cases that might fail and defer reimplantation if necessary. Thus, a reliable test providing information about the control of infection and risk of subsequent failure is necessary.Questions/purposes (1) At second-stage reimplantation surgery, what is the diagnostic accuracy of frozen sections as compared with the Musculoskeletal Infection Society (MSIS) as the gold standard? (2) What are the diagnostic accuracy parameters for the MSIS criteria and frozen sections in predicting failure of reimplantation? (3) Do positive MSIS criteria or frozen section at the time of reimplantation increase the risk of subsequent failure? Methods A total of 97 patients undergoing the second stage of revision total hip arthroplasty or total knee arthroplasty in 2013 for a diagnosis of periprosthetic joint infection (PJI) were considered eligible for the study. Of these, 11 had incomplete MSIS criteria and seven lacked 1-year followup, leaving 79 patients (38 knees and 41 hips) available for analysis. At the time of reimplantation, frozen section results were compared with modified MSIS criteria as the gold standard in detecting infection. Subsequently, success or failure of reimplantation was defined by (1) control of infection, as characterized by a healed wound without fistula, drainage, or pain; (2) no subsequent surgical intervention for infection after reimplantation surgery; and (3) no occurrence of PJI-related mortality; and diagnostic parameters in predicting treatment failure were calculated for both the modified MSIS criteria and frozen sections.One author (WB) has received research support in the amount of USD 100,001 to USD 1,000,000 from grants from Stryker (Kalamazoo, Conclusions On the basis of our results, both frozen section and MSIS are recommended at the time of the second stage of revision arthroplasty. Both frozen section and modified MSIS criteria had limited screening capabilities to identify failure, although both demonstrated high specificity. MSIS criteria should be evaluated at the second stage of revision arthroplasty because performing reimplantation in a joint that is positive for infection significantly increases the risk for subsequent failure. Level of Evidence Level III, diagnostic study.MI123 Clin Orthop Relat Res (2016) 474:1619-1626 DOI 10.1007/s11999-015-4673-3 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® Results At the time of second-stage reimplantation sur

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“…This would make the comparisons of different studies easier and would allow doing more precise meta-analysis of the available literature. A Delphi-method based study by our group attempted to define criteria for successful outcome aiming to establish basis for future research [52].…”

Section: Treatmentmentioning

confidence: 99%

Infection post-total knee replacement: current concepts

Alijanipour

Parvızı

2014

Curr Rev Musculoskelet Med

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Periprosthetic joint infection is a hot topic for investigation because it represents a challenging clinical problem with considerable burden for patients, institutions, and health systems. Despite our substantial knowledge, many details in prevention, pathophysiology, diagnosis, and treatment of infectious complications following total knee arthroplasty remain to be controversial with the available evidence being insufficient and at times conflictive. This manuscript is an attempt to approach the most recently published literature regarding the aforementioned details and aims to provide the reader with an updated perspective in the management of periprosthetic joint infection of the knee.

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Success After Treatment of Periprosthetic Joint Infection: A Delphi-based International Multidisciplinary Consensus

Abstract: Background The lack of agreement regarding what constitutes successful treatment for periprosthetic joint infections (PJI) makes it difficult to compare the different strategies of management that are used in clinical practice and in research studies.

Cited by 293 publications

References 39 publications

Synovial Cytokines and the MSIS Criteria Are Not Useful for Determining Infection Resolution After Periprosthetic Joint Infection Explantation

Synovial Cytokines and the MSIS Criteria Are Not Useful for Determining Infection Resolution After Periprosthetic Joint Infection Explantation

Are Frozen Sections and MSIS Criteria Reliable at the Time of Reimplantation of Two-stage Revision Arthroplasty?

Infection post-total knee replacement: current concepts

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