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. 2019 Mar;139(3):317-322.
doi: 10.1007/s00402-018-3058-y. Epub 2018 Oct 29.

A new perspective on current prosthetic joint infection classifications: introducing topography as a key factor affecting treatment strategy

Antonio Pellegrini  1 , Claudio Legnani  2 , Enzo Meani  1
Affiliations

A new perspective on current prosthetic joint infection classifications: introducing topography as a key factor affecting treatment strategy

Antonio Pellegrini et al. Arch Orthop Trauma Surg. 2019 Mar.

Abstract

Periprosthetic joint infection (PJI) is a relatively frequent and devastating complication following prosthetic joint implantation. Several classification systems have been presented by various authors and are routinely used in clinical practice to help in early diagnosis and treatment. The most widely accepted classifications of periprosthetic infections rely on the timing of clinical presentation. Unfortunately, these schemes possess important shortcomings which limit their usefulness in clinical practice, as data reported in literature are contrasting, with success rate ranging from 60 to 80%, irrespectively of prosthetic infection timing. An attempt is made by us to update the current knowledge on PJIs by looking them from a different perspective, introducing a topographic principle in their classification. Our approach is based on the theory that identifying the exact location of the bacterial colonization may allow to decide whether to conservatively treat the patient or to perform a more radical intervention. The aim is to improve the understanding of the aetiology of this serious complication, lead to the appropriate treatment strategy according to the stage of the disease thus enhancing the outcomes of surgical management. Such a strategy, if widely accepted, could guide research studies on the management of PJIs. The availability of investigations like scintigraphy could aid in identifying pathogenetic processes and their exact location, which may be missed on conventional radiographs, and could enable orthopaedic surgeons to have a better understanding of PJI patterns.

Keywords: Classification; Periprosthetic joint infection; Topography.

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Conflict of interest statement

Each author discloses any financial and personal relationships (e.g., employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, grants or other funding) that might pose a conflict of interest in connection with the submitted article.

Figures

Fig. 1
Fig. 1
Radiolabeled white blood cells (WBC) imaging showing infection involvement of the soft tissues of the joint space
Fig. 2
Fig. 2
Radiolabeled WBC imaging showing infection involvement of the bone–implant interface
Fig. 3
Fig. 3
Radiolabeled WBC imaging showing infection involvement of both joint space and bone–implant interface
Fig. 4
Fig. 4
Proposal of an update of current algorithm for prosthetic joint infection treatment introducing topography
See this image and copyright information in PMC

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