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Meta-Analysis
. 2017 Mar 9;22(1):8.
doi: 10.1186/s40001-017-0245-1.

Prosthetic joint infection development of an evidence-based diagnostic algorithm

Heinrich M L Mühlhofer  1 , Florian Pohlig  2 , Karl-Georg Kanz  3 , Ulrich Lenze  2 , Florian Lenze  2 , Andreas Toepfer  2 , Sarah Kelch  2 , Norbert Harrasser  2 , Rüdiger von Eisenhart-Rothe  2 , Johannes Schauwecker  2
Affiliations
Meta-Analysis

Prosthetic joint infection development of an evidence-based diagnostic algorithm

Heinrich M L Mühlhofer et al. Eur J Med Res. .

Abstract

Background: Increasing rates of prosthetic joint infection (PJI) have presented challenges for general practitioners, orthopedic surgeons and the health care system in the recent years. The diagnosis of PJI is complex; multiple diagnostic tools are used in the attempt to correctly diagnose PJI. Evidence-based algorithms can help to identify PJI using standardized diagnostic steps.

Methods: We reviewed relevant publications between 1990 and 2015 using a systematic literature search in MEDLINE and PUBMED. The selected search results were then classified into levels of evidence. The keywords were prosthetic joint infection, biofilm, diagnosis, sonication, antibiotic treatment, implant-associated infection, Staph. aureus, rifampicin, implant retention, pcr, maldi-tof, serology, synovial fluid, c-reactive protein level, total hip arthroplasty (THA), total knee arthroplasty (TKA) and combinations of these terms.

Results: From an initial 768 publications, 156 publications were stringently reviewed. Publications with class I-III recommendations (EAST) were considered. We developed an algorithm for the diagnostic approach to display the complex diagnosis of PJI in a clear and logically structured process according to ISO 5807.

Conclusions: The evidence-based standardized algorithm combines modern clinical requirements and evidence-based treatment principles. The algorithm provides a detailed transparent standard operating procedure (SOP) for diagnosing PJI. Thus, consistently high, examiner-independent process quality is assured to meet the demands of modern quality management in PJI diagnosis.

Keywords: Algorithm; Prosthetic joint infection; Revision surgery; THA; TKA; Total joint replacement.

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Figures

Fig. 1
Fig. 1
Flow chart of selection process
Fig. 2
Fig. 2
Diagnostic algorithm
See this image and copyright information in PMC

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