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

Published:October 31, 2019DOI:https://doi.org/10.1016/j.arth.2019.10.032

      Abstract

      Various definitions and biomarkers have been developed in an unsuccessful attempt to obtain a “gold standard” for periprosthetic joint infection (PJI) diagnosis. The development of the 2011 Musculoskeletal Infection Society criteria facilitated further research and advances by allowing the use of a consistent PJI definition across studies. The newly proposed 2018 criteria do not rely at all on expert opinions/consensus. In this review, we describe the most relevant definitions developed throughout recent time, their rationale, characteristics, and supportive evidence for their clinical implementation. In the opinion of the authors, the orthopedic community should consider a probability and likelihood paradigm to create a PJI diagnostic definition. Probably not a single definition might be suited for all situations; the inclusion of serological findings could be the next step moving forward.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic and Personal
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Kurtz S.M.
        • Lau E.
        • Watson H.
        • Schmier J.K.
        • Parvizi J.
        Economic Burden of periprosthetic joint infection in the United States.
        J Arthroplasty. 2012; 27: 61-65.e1https://doi.org/10.1016/j.arth.2012.02.022
        • Parvizi J.
        • Zmistowski B.
        • Berbari E.
        • Bauer T.
        • Springer B.
        • Della Valle C.
        • et al.
        New definition for periprosthetic joint infection: from the workgroup of the musculoskeletal infection society.
        Clin Orthop Relat Res. 2011; 469: 2992-2994https://doi.org/10.1007/s11999-016-5088-5
        • Parvizi J.
        • Gehrke T.
        Definition of periprosthetic joint infection.
        J Arthroplasty. 2014; 29: 1331https://doi.org/10.1016/j.arth.2014.03.009
        • Osmon D.R.
        • Berbari E.F.
        • Berendt A.R.
        • Lew D.
        • Zimmerli W.
        • Steckelberg J.M.
        • et al.
        Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the infectious Diseases society of America.
        Clin Infect Dis. 2013; 56: 1-25https://doi.org/10.1093/cid/cis803
        • Parvizi J.
        • Tan T.L.
        • Goswami K.
        • Higuera C.
        • Della Valle C.
        • Chen A.F.
        • et al.
        The 2018 definition of periprosthetic hip and knee Infection : an evidence-based and validated criteria.
        J Arthroplasty. 2019; 33: 1309-1314.e2https://doi.org/10.1016/j.arth.2018.02.078
        • Saleh A.
        • Ramanathan D.
        • Siqueira M.B.P.
        • Klika A.K.
        • Barsoum W.K.
        • Higuera Rueda C.A.
        The diagnostic utility of synovial fluid markers in periprosthetic joint Infection : a systematic review and meta-analysis.
        J Am Acad Orthop Surg. 2017; 25: 763-772https://doi.org/10.5435/JAAOS-D-16-00548
        • Shohat N.
        • Bauer T.
        • Buttaro M.
        • Budhiparama N.
        • Cashman J.
        • Della Valle C.J.
        • et al.
        Hip and knee section, what is the definition of a periprosthetic joint infection (PJI) of the knee and the hip? Can the same criteria be used for both joints?: proceedings of international consensus on orthopedic infections.
        J Arthroplasty. 2019; 34: S325-S327https://doi.org/10.1016/j.arth.2018.09.045
        • Wyles C.C.
        • Larson D.R.
        • Houdek M.T.
        • Sierra R.J.
        • Trousdale R.T.
        Utility of synovial fluid aspirations in failed metal-on-metal total hip arthroplasty.
        J Arthroplasty. 2019; 28: 818-823https://doi.org/10.1016/j.arth.2012.11.006
        • Wyles C.
        • Van Demark III, R.E.
        • Sierra R.J.
        • Trousdale R.T.
        High rate of infection after aseptic revision of failed metal-on-metal total hip arthroplasty.
        Clin Infect Dis. 2014; 472: 509-516https://doi.org/10.1007/s11999-013-3157-6
        • Judd K.T.
        • Noiseux N.
        Concomitant infection and local metal reaction in patients undergoing revision of metal on metal total hip arthroplasty.
        Iowa Orthop J. 2011; 31: 59-63
        • George J.
        • Kwiecien G.
        • Klika A.K.
        • Ramanathan D.
        • Bauer T.W.
        • Barsoum W.K.
        • et al.
        Are frozen sections and MSIS criteria reliable at the time of reimplantation of two-stage revision Arthroplasty ?.
        Clin Orthop Relat Res. 2016; 474: 1619-1626https://doi.org/10.1007/s11999-015-4673-3
        • Frangiamore S.J.
        • Siqueira M.B.P.
        • Saleh A.
        • Daly T.
        • Higuera C.A.
        • Barsoum W.K.
        Synovial cytokines and the MSIS criteria are not useful for determining infection resolution after periprosthetic joint infection explantation.
        Clin Orthop Relat Res. 2016; 474: 1630-1639https://doi.org/10.1007/s11999-016-4710-x
        • Diaz-Ledezma C.
        • Higuera C.A.
        • Parvizi J.
        Success after treatment of periprosthetic joint Infection : a delphi-based international multidisciplinary consensus.
        Clin Orthop Relat Res. 2013; 471: 2374-2382https://doi.org/10.1007/s11999-013-2866-1
        • Kheir M.M.
        • Ackerman C.T.
        • Tan T.L.
        • Benazzo A.
        • Tischler E.H.
        • Parvizi J.
        Leukocyte esterase strip test can predict subsequent failure following reimplantation in patients with periprosthetic joint infection.
        J Arthroplasty. 2019; 32: 1976-1979https://doi.org/10.1016/j.arth.2017.01.031
        • Samuel L.T.
        • Sultan A.A.
        • Kheir M.
        • Villa J.
        • Patel P.
        • Parvizi J.
        • et al.
        Positive alpha-defensin at reimplantation of a two-stage revision arthroplasty is not associated with infection at 1 year.
        Clin Orthop Relat Res. 2019; 477: 1615-1621https://doi.org/10.1097/CORR.0000000000000620
        • Tsaras G.
        • Maduka-Ezeh A.
        • Inwards C.Y.
        • Mabry T.
        • Erwin P.J.
        • Murad H.M.
        • et al.
        Utility of intraoperative frozen section histopathology in the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis.
        J Bone Joint Surg Am. 2012; 94: 1700-1711
        • Kwiecien G.
        • George J.
        • Klika A.K.
        • Zhang Y.
        • Bauer T.W.
        • Higuera Rueda C.A.
        Intraoperative frozen section Histology : matched for musculoskeletal infection society criteria.
        J Arthroplasty. 2019; 32: 223-227https://doi.org/10.1016/j.arth.2016.06.019
        • Gehrke T.
        • Lausmann C.
        • Citak M.
        • Bonanzinga T.
        • Frommelt L.
        • Zahar A.
        The accuracy of the alpha defensin lateral flow test for diagnosis of periprosthetic joint infection.
        J Bone Joint Surg Am. 2018; 100: 42-48https://doi.org/10.2106/JBJS.16.01522
        • Renz N.
        • Yermak K.
        • Perka C.
        • Trampuz A.
        Alpha defensin lateral flow test for diagnosis of periprosthetic joint infection.
        J Bone Joint Surg Am. 2018; 100: 742-750https://doi.org/10.2106/JBJS.17.01005
        • Shahi A.
        • Kheir M.M.
        • Tarabichi M.
        • Hosseinzadeh H.R.S.
        • Tan T.L.
        • Parvizi J.
        Serum D-dimer test is promising for the diagnosis of periprosthetic joint infection and timing of reimplantation.
        J Bone Joint Surg Am. 2017; 99: 1419-1427
        • Li R.
        • Shao H.-Y.
        • Hao L.-B.
        • Yu B.-Z.
        • Qu P.-F.
        • Zhou Y.-X.
        • et al.
        Plasma fibrinogen exhibits better performance than plasma D-dimer in the diagnosis of periprosthetic joint infection: a multicenter retrospective study.
        J Bone Joint Surg Am. 2019; 101: 613-619
        • Xu H.
        • Xie J.
        • Huang Q.
        • Lei Y.
        • Zhang S.
        • Pei F.
        Plasma fibrin degradation product and D-dimer are of limited value for diagnosing periprosthetic joint infection.
        J Arthroplasty. 2019; 34: 2454-2460https://doi.org/10.1016/j.arth.2019.05.009