International Consensus on Periprosthetic Joint Infection: Description of the Consensus Process

Category: Other Introduction/Purpose: Periprosthetic joint infection (PJI) affects 2-3% of all total joint replacement cases. In 10-30% of these cases, the organism is unidentifiable, which may impact treatment planning and outcomes. In this study, suspected periprosthetic infections of foot and ankle procedures treated by four foot and ankle-trained orthopaedic surgeons were retrospectively reviewed to determine culture status and applicability of the 2018 International Consensus Meeting on Orthopaedic Infections (ICM) Revision classification system. Methods: Under an IRB-approved protocol, cases of suspected infection, based on ICD-9/10 codes, from cases performed at a Level 1, private, academic hospital from October 2014 to November 2019 were reviewed for demographic, surgical, and infection-related data. Results: Of the 210 revision cases coded for infection, 82 met the inclusion criteria of the study; cases included removal of an implant and were not wound infection-related only. Preoperatively and intraoperatively, 10 (12%) and 59 (72%) cases were culture-positive, respectively. In this series, 21 (26%) cases met the ICM Revision major criteria and 36 (44%) cases met the threshold for ICM Revision minor criteria; overall, 43 (52%) cases were defined as infected by the 2018 ICM Revision classification system. Conclusion: This study reviewed and identified culture status and infection by the 2018 ICM classification system. In this series of 82 cases, approximately half of the cases met the criteria for infection diagnosis, according to the most recently revised ICM classification system, although nearly three-quarters of the population had at least one positively-identified intraoperative culture. Further data analysis is ongoing to assess the correlation between ICM scoring with pre/postoperative treatment and outcomes. [Table: see text]

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Editorial: Consensus Statement From The International Consensus Meeting on Periprosthetic Joint Infection

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-013-3330-y ◽

2013 ◽

Vol 471 (12) ◽

pp. 3731-3732 ◽

Cited By ~ 4

Author(s):

Seth S. Leopold

Keyword(s):

Periprosthetic Joint Infection ◽

Consensus Statement ◽

Joint Infection ◽

Consensus Meeting ◽

International Consensus

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Comparison of Synovial Fluid and Serum Procalcitonin for Diagnosis of Periprosthetic Joint Infection: A Pilot Study in 32 Patients

BioMed Research International ◽

10.1155/2018/8351308 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Paphon Sa-ngasoongsong ◽

Siwadol Wongsak ◽

Chavarat Jarungvittayakon ◽

Kawee Limsamutpetch ◽

Thanaphot Channoom ◽

...

Keyword(s):

Synovial Fluid ◽

Aseptic Loosening ◽

Periprosthetic Joint Infection ◽

Characteristic Curve ◽

Joint Infection ◽

Laboratory Data ◽

Negative Likelihood Ratio ◽

Joint Fluid ◽

International Consensus ◽

Standard Methods

Background. Periprosthetic joint infection (PJI) remains challenging since a “gold standard” for diagnosis has not yet been established. This study aimed to evaluate the accuracy of synovial fluid procalcitonin (SF-PCT) and serum procalcitonin as a diagnostic biomarker for PJI and to compare its accuracy against standard methods. Methods. A prospective cohort study was conducted during 2015–2017 in 32 patients with painful hip or knee arthroplasty who have underwent revision surgery. Relevant clinical and laboratory data were collected. PJI was diagnosed based on the 2013 international consensus criteria. Preoperative blood sample and intraoperatively acquired joint fluid were taken for PCT measurement with a standard assay. Diagnostic accuracy was analyzed by the receiver-operating characteristic curve and the area under the curve (AUC). Results. Twenty patients (62.5%) were classified as the PJI group, and 12 (37.5%) were classified as the aseptic loosening group. The median age was 68 years (range 38–87 years). The median values of SF-PCT and serum PCT in the PJI group were both significantly higher than those in the aseptic loosening group: the median serum PCT levels (interquartile range: IQR) were 0.33 ng/mL (0.08-2.79 ng/mL) in the PJI group compared with 0.04 ng/mL (0.03-0.06 ng/mL), and the median SF-PCT levels (IQR) were 0.16 ng/mL (0.12-0.26 ng/mL) in PJI group compared with 0.00 (0.00-0.00 ng/mL) (p<0.001, both). SF-PCT, with a cut-off level of 0.08 ng/mL, had an AUC of 0.87, a sensitivity of 90.0%, a specificity of 83.3%, and a negative likelihood ratio (LR-) of 0.12. Serum PCT, with a standard cut-off level of 0.5 ng/mL, had an AUC of 0.70, a sensitivity of 40.0%, a specificity of 100.0%, and a LR- of 0.60. Conclusion. SF-PCT appears to be a reliable test and could be useful as an alternative indicator or in combination with standard methods for diagnosing PJI.

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Periprosthetic joint infections of the shoulder: A 10-year retrospective analysis outlining the heterogeneity among these patients

Shoulder & Elbow ◽

10.1177/17585732211019010 ◽

2021 ◽

pp. 175857322110190

Author(s):

Taylor Paziuk ◽

Ryan M Cox ◽

Michael J Gutman ◽

Alexander J Rondon ◽

Thema Nicholson ◽

...

Keyword(s):

Periprosthetic Joint Infection ◽

Shoulder Arthroplasty ◽

Joint Infection ◽

Sinus Tract ◽

Difficult Problem ◽

Consensus Meeting ◽

International Consensus ◽

Joint Infections ◽

Revision Shoulder Arthroplasty ◽

Culture Negative

Background Diagnosis and treatment of shoulder periprosthetic joint infection is a difficult problem. The purpose of this study was to utilize the 2018 International Consensus Meeting definition of shoulder periprosthetic joint infection to categorize revision shoulder arthroplasty cases and determine variations in clinical presentation by presumed infection classification. Methods Retrospective review of patients undergoing revision shoulder arthroplasty at a single institution. Likelihood of periprosthetic joint infection was determined based on International Consensus Meeting scoring. All patients classified as definitive or probable periprosthetic joint infection were classified as periprosthetic joint infection. All patients classified as possible or unlikely periprosthetic joint infection were classified as aseptic. The periprosthetic joint infection cohort was subsequently divided into culture-negative, non-virulent microorganism, and virulent microorganism cohorts based on culture results. Results Four hundred and sixty cases of revision shoulder arthroplasty were reviewed. Eighty (17.4%) patients were diagnosed as definite or probable periprosthetic joint infection, of which 29 (36.3%), 39 (48.8%), and 12 (15.0%) were classified as virulent, non-virulent, or culture-negative periprosthetic joint infection, respectively. There were significant differences among periprosthetic joint infection subgroups with regard to preoperative C-reactive protein (p = 0.020), erythrocyte sedimentation rate (p = 0.051), sinus tract presence (p = 0.008), and intraoperative purulence (p < 0.001). The total International Consensus Meeting criteria scores were also significantly different between the periprosthetic joint infection cohorts (p < 0.001). Discussion While the diagnosis of shoulder periprosthetic joint infection has improved with the advent of International Consensus Meeting criteria, there remain distinct differences between periprosthetic joint infection classifications that warrant further investigation to determine the accurate diagnosis and optimal treatment.

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