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. 2022 Sep;11(9):608-618.
doi: 10.1302/2046-3758.119.BJR-2022-0078.R1.

Diagnosing periprosthetic joint infections : a comparison of infection definitions: EBJIS 2021, ICM 2018, and IDSA 2013

Irene K Sigmund  1 , Markus Luger  1 , Reinhard Windhager  1 , Martin A McNally  2
Affiliations

Diagnosing periprosthetic joint infections : a comparison of infection definitions: EBJIS 2021, ICM 2018, and IDSA 2013

Irene K Sigmund et al. Bone Joint Res. 2022 Sep.

Abstract

Aims: This study evaluated the definitions developed by the European Bone and Joint Infection Society (EBJIS) 2021, the International Consensus Meeting (ICM) 2018, and the Infectious Diseases Society of America (IDSA) 2013, for the diagnosis of periprosthetic joint infection (PJI).

Methods: In this single-centre, retrospective analysis of prospectively collected data, patients with an indicated revision surgery after a total hip or knee arthroplasty were included between 2015 and 2020. A standardized diagnostic workup was performed, identifying the components of the EBJIS, ICM, and IDSA criteria in each patient.

Results: Of 206 included patients, 101 (49%) were diagnosed with PJI with the EBJIS definition. IDSA and ICM diagnosed 99 (48%) and 86 (42%) as infected, respectively. A total of 84 cases (41%) had an infection based on all three criteria. In 15 cases (n = 15/206; 7%), PJI was present when applying only the IDSA and EBJIS criteria. No infection was detected by one definition alone. Inconclusive diagnoses occurred more frequently with the ICM criteria (n = 30/206; 15%) compared to EBJIS (likely infections: n = 16/206; 8%) (p = 0.029). A better preoperative performance of the EBJIS definition was seen compared with the ICM and IDSA definitions (p < 0.001).

Conclusion: The novel EBJIS definition identified all PJIs diagnosed by any other criteria. Use of the EBJIS definition significantly reduced the number of uncertain diagnoses, allowing easier clinical decision-making.Cite this article: Bone Joint Res 2022;11(9):608-618.

Keywords: CRP; Diagnosis; Infection definition; Infectious Diseases; Joint Infection; Periprosthetic joint infection; Synovial fluid; infections; periprosthetic joint infections (PJIs); retrospective analysis; revision arthroplasty; revision surgery; revision total hip arthroplasty; revision total knee arthroplasty; total hip or knee arthroplasty.

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Figures

Fig. 1
Fig. 1
Detected infections when using the European Bone and Joint Infection Society (EBJIS), Infectious Diseases Society of America (IDSA), and International Consensus Meeting (ICM) definitions.
Fig. 2
Fig. 2
The percentage of patients who fulfilled one, two, three, four, five, or six confirmatory criteria when using the European Bone and Joint Infection Society (EBJIS) definition or Infectious Diseases Society of America (IDSA) definition.
Fig. 3
Fig. 3
Venn diagram of the detected infections based on the European Bone and Joint Infection Society (EBJIS), Infectious Diseases Society of America (IDSA), and International Consensus Meeting (ICM) definitions.
Fig. 4
Fig. 4
Distribution of the whole study cohort when using the International Consensus Meeting (ICM) definition.
Fig. 5
Fig. 5
Distribution of the whole study cohort when using the European Bone and Joint Infection Society (EBJIS) definition.
Fig. 6
Fig. 6
Receiver operating characteristic curves for accuracy of preoperative diagnosis of the three infection definitions (European Bone and Joint Infection Society (EBJIS), International Consensus Meeting (ICM), and Infectious Diseases Society of America (IDSA)) compared to definitive diagnosis.
See this image and copyright information in PMC

References

    1. Osmon DR, Berbari EF, Berendt AR, 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):e1–e25. 10.1093/cid/cis803 - DOI - PubMed
    1. McNally M, Sousa R, Wouthuyzen-Bakker M, et al. . The EBJIS definition of periprosthetic joint infection. Bone Joint J. 2021;103-B(1):18–25. 10.1302/0301-620X.103B1.BJJ-2020-1381.R1 - DOI - PMC - PubMed
    1. Parvizi J, Zmistowski B, Berbari EF, et al. . New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res. 2011;469(11):2992–2994. 10.1007/s11999-011-2102-9 - DOI - PMC - PubMed
    1. Parvizi J, Gehrke T, International Consensus Group on Periprosthetic Joint Infection . Definition of periprosthetic joint infection. J Arthroplasty. 2014;29(7):1331. 10.1016/j.arth.2014.03.009 - DOI - PubMed
    1. Parvizi J, Tan TL, Goswami K, et al. . The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty. 2018;33(5):1309–1314. 10.1016/j.arth.2018.02.078 - DOI - PubMed