Articles | Volume 8, issue 1
https://doi.org/10.5194/jbji-8-29-2023
© Author(s) 2023. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-8-29-2023
© Author(s) 2023. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Guidelines/recommendations/consensus paper
| 
12 Jan 2023
Guidelines/recommendations/consensus paper |
| 12 Jan 2023
| 12 Jan 2023
Guideline for management of septic arthritis in native joints (SANJO)
Dept. of Orthopaedic Surgery and Traumatology, Aarhus University
Hospital, Aarhus, Denmark
Members of the Steering Committee for the EBJIS Guideline Project on SANJO
Jeroen Neyt
CORRESPONDING AUTHOR
Dept. of Orthopedic Surgery, University Hospitals Ghent, Ghent, Belgium
Members of the Steering Committee for the EBJIS Guideline Project on SANJO
Natividad Benito
Dept. of Infectious Diseases, Hospital de la Santa Creu i Sant Pau,
Barcelona, Spain
Members of the Steering Committee for the EBJIS Guideline Project on SANJO
Miguel Araújo Abreu
Dept. of Infectious Diseases, Centro Hospitalar do Porto, Porto, Portugal
Yvonne Achermann
Dept. of Internal Medicine, Hospital Zollikerberg, Zürich, Switzerland
Svetlana Bozhkova
Dept. of Prevention and Treatment of Wound Infection, Vreden National Medical Research Center of Traumatology and Orthopedics, St. Petersburg, Russia
Liselotte Coorevits
Dept. of Clinical Microbiology, University Hospitals Ghent, Ghent, Belgium
Matteo Carlo Ferrari
Dept. of Internal Medicine, IRCCS Ospedale Galeazzi Sant'Ambrogio,
Milano, Italy
Karianne Wiger Gammelsrud
Dept. of Clinical Microbiology, University Hospital Oslo, Oslo, Norway
Ulf-Joachim Gerlach
Dept. of Septic Orthopedic Surgery and Traumatology, BG Klinikum
Hamburg, Hamburg, Germany
Efthymia Giannitsioti
Dept. of Infectious Diseases, Attikon University General Hospital,
Athens, Greece
Martin Gottliebsen
Dept. of Orthopaedic Surgery and Traumatology, Aarhus University
Hospital, Aarhus, Denmark
Nis Pedersen Jørgensen
Dept. of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
Tomislav Madjarevic
Dept. of Orthopaedic Surgery Lovran, University of Rijeka, Rijeka, Croatia
Leonard Marais
Dept. of Orthopaedic Surgery, University of KwaZulu-Natal, Durban, South Africa
Aditya Menon
Dept. of Orthopaedics, P.D. Hinduja Hospital and Medical Research
Centre, Mumbai, India
Dirk Jan Moojen
Dept. of Orthopaedic and Trauma Surgery, OLVG Amsterdam, Amsterdam, the Netherlands
Markus Pääkkönen
Dept. of Orthopaedics and Traumatology, Turku University Hospital,
Turku, Finland
Marko Pokorn
Dept. of Infectious Diseases, Ljubjana University Medical Center,
Ljubjana, Slovenia
Daniel Pérez-Prieto
Dept. of Orthopaedic Surgery and Traumatology, Hospital del Mar,
Barcelona, Spain
Nora Renz
Dept. of Infectious Diseases, Bern University Hospital, Bern, Switzerland
Jesús Saavedra-Lozano
Dept. of Pediatric Infectious Diseases Unit, Gregorio Marañón
Hospital, Madrid, Spain
Marta Sabater-Martos
Dept. of Orthopaedic Surgery and Traumatology, Hospital Clínic,
Barcelona, Spain
Parham Sendi
Dept. of Infectious Diseases, University Hospital of Basel, Basel, Switzerland
Institute for Infectious Diseases, University of Bern, Bern, Switzerland
Staffan Tevell
Dept. of Infectious Diseases, Karlstad Hospital and Centre for Clinical
Research, Karlstad, Sweden
Charles Vogely
Dept. of Orthopedic Surgery, University Medical Center Utrecht, Utrecht, the
Netherlands
Members of the Steering Committee for the EBJIS Guideline Project on SANJO
Alex Soriano
Dept. of Infectious Diseases, Hospital Clínic, Barcelona, Spain
Members of the Steering Committee for the EBJIS Guideline Project on SANJO
A full list of authors appears at the end of the paper.
Editorial note: The supplement to this article was adjusted on 2 February 2023. The section "Workshop report 7" was shortened.
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This is a meta-analysis of six studies describing the cutoff values of white blood cell count and polymorphonuclear percentage in synovial fluid for the diagnosis of acute postoperative peri-prosthetic joint infection (PJI).
We found that both the WBC count and PMN percentage are good markers for diagnosis of acute postoperative PJI. However, the synovial WBC count is more powerful in diagnosing acute postoperative PJI.
We found that both the WBC count and PMN percentage are good markers for diagnosis of acute postoperative PJI. However, the synovial WBC count is more powerful in diagnosing acute postoperative PJI.
Leonard C. Marais, Luan Nieuwoudt, Adisha Nansook, Aditya Menon, and Natividad Benito
J. Bone Joint Infect., 8, 189–207, https://doi.org/10.5194/jbji-8-189-2023, https://doi.org/10.5194/jbji-8-189-2023, 2023
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Tuberculosis (TB) primarily involves the lungs, but it may spread to other sites including joints. TB arthritis, is relatively rare, but it can result in severe damage to the joint and, ultimately, significant functional impairment. This article reviews the current literature on the topic and identifies key areas where further scientific research is needed to improve the diagnosis and management of the disease.
Sara Elisa Diniz, Ana Ribau, André Vinha, José Carlos Oliveira, Miguel Araújo Abreu, and Ricardo Sousa
J. Bone Joint Infect., 8, 109–118, https://doi.org/10.5194/jbji-8-109-2023, https://doi.org/10.5194/jbji-8-109-2023, 2023
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While there is no gold standard test to diagnose periprosthetic joint infection (PJI), we believe synovial fluid analysis, especially preoperatively, is a critical step in differentiating between infection and aseptic failure. Adding simple and inexpensive biomarkers such as synovial C-reactive protein (CRP) or adenosine deaminase (ADA) and combined interpretation can be helpful in the context of inconclusive results.
Efthymia Giannitsioti, Mauro José Salles, Andreas Mavrogenis, Dolors Rodriguez-Pardo, Ibai Los-Arcos, Alba Ribera, Javier Ariza, María Dolores del Toro, Sophie Nguyen, Eric Senneville, Eric Bonnet, Monica Chan, Maria Bruna Pasticci, Sabine Petersdorf, Natividad Benito, Nuala O' Connell, Antonio Blanco García, Gábor Skaliczki, Pierre Tattevin, Zeliha Kocak Tufan, Nikolaos Pantazis, Panayiotis D. Megaloikonomos, Panayiotis Papagelopoulos, Alejandro Soriano, Antonios Papadopoulos, and the ESGIAI collaborators study group
J. Bone Joint Infect., 7, 279–288, https://doi.org/10.5194/jbji-7-279-2022, https://doi.org/10.5194/jbji-7-279-2022, 2022
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Our multicentre study on a lower-limb osteosynthesis-associated infection (OAI) cohort by multidrug (MDR) and extensively drug (XDR) resistant Gram-negative bacteria found the following: implant retention with debridement was mostly performed in early OAI; 50.9 % of patients achieved remission of infection; remission reached 50 % (MDR) vs. 25 % (XDR) in early OAI and 60 % (MDR) vs. 44.4 % (XDR) in late OAI; age (> 60) and multiple surgeries were independent factors influencing lack of remission.
Ernesto Muñoz-Mahamud, Eduard Tornero, José A. Estrada, Jenaro A. Fernández-Valencia, Juan C. Martínez-Pastor, and Álex Soriano
J. Bone Joint Infect., 7, 109–115, https://doi.org/10.5194/jbji-7-109-2022, https://doi.org/10.5194/jbji-7-109-2022, 2022
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A patient with normal D-dimer value has a low risk of prosthetic joint infection, so serum D-dimer assessment should always be considered as a useful test to rule out chronic prosthetic joint infection (especially in those cases caused by low-virulence microorganisms in which conventional tests may lead to misdiagnosis). Conversely, the platelet count to mean platelet volume ratio may be of limited value for accurately diagnosing prosthetic joint infection.
Simon Martin Heinrich, Parham Sendi, and Martin Clauss
J. Bone Joint Infect., 6, 423–424, https://doi.org/10.5194/jbji-6-423-2021, https://doi.org/10.5194/jbji-6-423-2021, 2021
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We report on an 83-year-old woman who had an open removal of a baker's cyst several months after total knee arthroplasty. The following wound healing problem was first misinterpreted as being superficial. With an injection of methylene blue and a contrast medium, we showed the extent of the sinus tract, proving the periprosthetic joint infection.
Diana Salomi Ponraj, Thomas Falstie-Jensen, Nis Pedersen Jørgensen, Christen Ravn, Holger Brüggemann, and Jeppe Lange
J. Bone Joint Infect., 6, 367–378, https://doi.org/10.5194/jbji-6-367-2021, https://doi.org/10.5194/jbji-6-367-2021, 2021
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Implant-associated infections (IAIs) in orthopaedic surgery are associated with high morbidity and mortality. Slow-growing anaerobic bacteria are increasingly being recognized as potential causative agents in such infections, but their diagnosis is difficult. The purpose of this review is to summarize the current knowledge of IAIs with these bacteria. In particular, the review gives an overview of the current methodology in the diagnosis of such infections, to serve as a guide for clinicians.
Karel-Jan Dag François Lensen, Rosa Escudero-Sanchez, Javier Cobo, Rihard Trebše, Camelia Gubavu, Sara Tedeschi, Jose M. Lomas, Cedric Arvieux, Dolors Rodriguez-Pardo, Massimo Fantoni, Maria Jose Garcia Pais, Francisco Jover, Mauro José Costa Salles, Ignacio Sancho, Marta Fernandez Sampedro, Alex Soriano, Marjan Wouthuyzen-Bakker, and ESCMID Study Group of Implant Associated Infections (ESGIAI)
J. Bone Joint Infect., 6, 313–319, https://doi.org/10.5194/jbji-6-313-2021, https://doi.org/10.5194/jbji-6-313-2021, 2021
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Our data suggest that, in periprosthetic joint infection (PJI) patients with a draining sinus, suppressive antibiotic treatment (SAT) can be considered on an individual basis. SAT may reduce pain and favour the closure of the sinus tract in certain individuals, but the prescription of SAT does not appear to have any influence on the prevention of prosthetic loosening and other infectious complications.
André Dias Carvalho, Ana Ribau, Daniel Soares, Ana Claudia Santos, Miguel Abreu, and Ricardo Sousa
J. Bone Joint Infect., 6, 305–312, https://doi.org/10.5194/jbji-6-305-2021, https://doi.org/10.5194/jbji-6-305-2021, 2021
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When we initiated this paper, there was no evidence on what kind of spacers we should use. Our work was to prove that we must use a broad spectrum of antibiotics at the spacers in two-stage revision procedures. We demonstrate that a large spectrum of antibiotics at the spacer results in a lower rate of positive cultures during preimplantation and, subsequently, better outcomes and lower rate of infection.
Ernesto Muñoz-Mahamud, Jenaro Ángel Fernández-Valencia, Andreu Combalia, Laura Morata, and Álex Soriano
J. Bone Joint Infect., 6, 85–90, https://doi.org/10.5194/jbji-6-85-2021, https://doi.org/10.5194/jbji-6-85-2021, 2021
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A plausible cause of persistent infection after septic hip revision may be the presence of nonviable osteomyelitic bone. We present our initial experience in hip revision for chronic infection in which fluorescent tetracycline bone labeling was used as an additional aid to provide a visual index of surgical bone debridement. In the present series, the use of this technique successfully aided the surgeon to detect the presence of nonviable bone.
Karel-Jan Lensen, Rosa Escudero-Sanchez, Javier Cobo, Alex Soriano, and Marjan Wouthuyzen-Bakker
J. Bone Joint Infect., 6, 43–45, https://doi.org/10.5194/jbji-6-43-2020, https://doi.org/10.5194/jbji-6-43-2020, 2020
Cited articles
Guyatt, G. H., Oxman, A. D., Kunz, R., Falck-Ytter, Y., Vist, G. E.,
Liberati, A., Schunemann, H. J., and Group, G. W.: Going from evidence to
recommendations, BMJ, 336, 1049–1051, https://doi.org/10.1136/bmj.39493.646875.AE, 2008.
Stutz, G., Kuster, M. S., Kleinstuck, F., and Gachter, A.: Arthroscopic
management of septic arthritis: stages of infection and results, Knee Surg.
Sports Traumatol. Arthrosc., 8, 270–274, https://doi.org/10.1007/s001670000129, 2000.
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Short summary
Management of septic arthritis in native joints (SANJO) is often conducted by clinicians of different specialties, experience levels, and at all hours of the day. The SANJO guideline group makes evidence-based recommendations for diagnosis, microbiological investigation, initial surgery, empirical antibiotic treatment, early mobilization, evaluation of outcomes, and treatment failure. Special considerations were made for children, tuberculosis, and SANJO after cruciate ligament reconstruction.
Management of septic arthritis in native joints (SANJO) is often conducted by clinicians of...
