Articles | Volume 9, issue 5
https://doi.org/10.5194/jbji-9-231-2024
© Author(s) 2024. 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-9-231-2024
© Author(s) 2024. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
Predicting periprosthetic joint infection: external validation of preoperative prediction models
Seung-Jae Yoon
Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
Paul C. Jutte
Department of Orthopaedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
Alex Soriano
Infectious Diseases Service, Clínic Barcelona, University of Barcelona, Barcelona, Spain
Ricardo Sousa
Porto Bone Infection Group (GRIP), Orthopaedic Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
Wierd P. Zijlstra
Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, the Netherlands
Marjan Wouthuyzen-Bakker
CORRESPONDING AUTHOR
Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
Related authors
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Laia Boadas-Gironès, Marta Sabater-Martos, Marc Ferrer-Banus, Àlex Soriano-Viladomiu, and Juan Carlos Martínez-Pastor
J. Bone Joint Infect., 9, 241–248, https://doi.org/10.5194/jbji-9-241-2024, https://doi.org/10.5194/jbji-9-241-2024, 2024
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When acute soft tissue defects are present after knee arthroplasty, the infection risk is high. A gastrocnemius flap is used for anterior defects, and it is not usually combined with debridement surgery unless infection is clear. We examined the benefit of combining coverage treatment with debridement surgery, DAIR, comparing the isolated traditional coverage treatment. The results suggested a higher healing rate in the combined treatment, so we recommended it.
Stéphanie Pascual, Brooklyn Noble, Nusreen Ahmad-Saeed, Catherine Aldridge, Simone Ambretti, Sharon Amit, Rachel Annett, Shaan Ashk O'Shea, Anna Maria Barbui, Gavin Barlow, Lucinda Barrett, Mario Berth, Alessandro Bondi, Nicola Boran, Sara E. Boyd, Catarina Chaves, Martin Clauss, Peter Davies, Ileana T. Dianzo-Delgado, Jaime Esteban, Stefan Fuchs, Lennart Friis-Hansen, Daniel Goldenberger, Andrej Kraševac Glaser, Juha O. Groonroos, Ines Hoffmann, Tomer Hoffmann, Harriet Hughes, Marina Ivanova, Peter Jezek, Gwennan Jones, Zeynep Ceren Karahan, Cornelia Lass-Flörl, Frédéric Laurent, Laura Leach, Matilde Lee Horsbøll Pedersen, Caroline Loiez, Maureen Lynch, Robert J. Maloney, Martin Marsh, Olivia Milburn, Shanine Mitchell, Luke S. P. Moore, Lynn Moffat, Marianna Murdjeva, Michael E. Murphy, Deepa Nayar, Giacomo Nigrisoli, Fionnuala O'Sullivan, Büşra Öz, Teresa Peach, Christina Petridou, Mojgan Prinz, Mitja Rak, Niamh Reidy, Gian Maria Rossolini, Anne-Laure Roux, Patricia Ruiz-Garbajosa, Kordo Saeed, Llanos Salar-Vidal, Carlos Salas Venero, Mathyruban Selvaratnam, Eric Senneville, Peter Starzengruber, Ben Talbot, Vanessa Taylor, Rihard Trebše, Deborah Wearmouth, Birgit Willinger, Marjan Wouthuyzen-Bakker, Brianne Couturier, and Florence Allantaz
J. Bone Joint Infect., 9, 87–97, https://doi.org/10.5194/jbji-9-87-2024, https://doi.org/10.5194/jbji-9-87-2024, 2024
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This study conducted in multiple sites across Europe aimed to evaluate the BIOFIRE Joint Infection (JI) Panel, a new technology that uses multiplex PCR to detect microorganisms in synovial fluid of patients with suspicion of joint infections in 1 h, in comparison with synovial fluid culture. Results showed an overall agreement of 85 % to 88.4 % between the two methods. The JI Panel detected additional organisms, and the positive user experience highlights its clinical significance.
Marta Sabater-Martos, Marc Ferrer, Laura Morata, Alex Soriano, and Juan Carlos Martínez-Pastor
J. Bone Joint Infect., 9, 17–26, https://doi.org/10.5194/jbji-9-17-2024, https://doi.org/10.5194/jbji-9-17-2024, 2024
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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.
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.
Henk Scheper, Rachid Mahdad, Brenda Elzer, Claudia Löwik, Wierd Zijlstra, Taco Gosens, Joris C. T. van der Lugt, Robert J. P. van der Wal, Rudolf W. Poolman, Matthijs P. Somford, Paul C. Jutte, Pieter K. Bos, Richard E. Zwaan, Rob G. H. H. Nelissen, Leo G. Visser, Mark G. J. de Boer, and the wound care app study group
J. Bone Joint Infect., 8, 59–70, https://doi.org/10.5194/jbji-8-59-2023, https://doi.org/10.5194/jbji-8-59-2023, 2023
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The relation between postoperative wound leakage and occurrence of a prosthetic joint infection (PJI) after arthroplasty has not been investigated in a prospective study. We performed a large cohort study in which 1019 patients, after arthroplasty, recorded their wound drainage status in a wound care app during 30 postoperative days. Risk factors for wound drainage were identified. Moderate to heavy wound leakage in the third postoperative week was strongly associated with the occurrence of PJI.
Jorrit Willem Adriaan Schoenmakers, Rosanne de Boer, Lilli Gard, Greetje Anna Kampinga, Marleen van Oosten, Jan Maarten van Dijl, Paulus Christiaan Jutte, and Marjan Wouthuyzen-Bakker
J. Bone Joint Infect., 8, 45–50, https://doi.org/10.5194/jbji-8-45-2023, https://doi.org/10.5194/jbji-8-45-2023, 2023
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In a first evaluation, the accuracy of a novel multiplex PCR (polymerase chain reaction) panel for rapid detection of pathogens in patients with a clinical suspicion of acute septic arthritis of native and prosthetic joints is assessed. Clear benefit is seen in patients with a suspected native septic arthritis and late acute prosthetic joint infection. This indicates that the panel allows for fast tailoring of antibiotics and may prompt the surgeon for surgical lavage in doubtful clinical cases.
Christen Ravn, Jeroen Neyt, Natividad Benito, Miguel Araújo Abreu, Yvonne Achermann, Svetlana Bozhkova, Liselotte Coorevits, Matteo Carlo Ferrari, Karianne Wiger Gammelsrud, Ulf-Joachim Gerlach, Efthymia Giannitsioti, Martin Gottliebsen, Nis Pedersen Jørgensen, Tomislav Madjarevic, Leonard Marais, Aditya Menon, Dirk Jan Moojen, Markus Pääkkönen, Marko Pokorn, Daniel Pérez-Prieto, Nora Renz, Jesús Saavedra-Lozano, Marta Sabater-Martos, Parham Sendi, Staffan Tevell, Charles Vogely, Alex Soriano, and the SANJO guideline group
J. Bone Joint Infect., 8, 29–37, https://doi.org/10.5194/jbji-8-29-2023, https://doi.org/10.5194/jbji-8-29-2023, 2023
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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.
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.
Marjan Wouthuyzen-Bakker and Alexander L. Boerboom
J. Bone Joint Infect., 7, 33–34, https://doi.org/10.5194/jbji-7-33-2022, https://doi.org/10.5194/jbji-7-33-2022, 2022
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This case illustrates the clinical picture of a worn-out elbow prosthesis resulting in severe metallosis and a subsequent periprosthetic joint infection.
Karsten D. Ottink, Stefan J. Gelderman, Marjan Wouthuyzen-Bakker, Joris J. W. Ploegmakers, Andor W. J. M. Glaudemans, and Paul C. Jutte
J. Bone Joint Infect., 7, 1–9, https://doi.org/10.5194/jbji-7-1-2022, https://doi.org/10.5194/jbji-7-1-2022, 2022
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A low-grade periprosthetic joint infection (PJI) may be difficult to diagnose, and nuclear imaging could help in the diagnosis. However, its diagnostic value is unclear. We retrospectively evaluated this diagnostic value. We conclude that in patients presenting with nonspecific symptoms and a low a priori chance of PJI based on clinical evaluation, nuclear imaging is of no clear added value in diagnosing a PJI.
Tom A. G. Van Vugt, Jeffrey Heidotting, Jacobus J. Arts, Joris J. W. Ploegmakers, Paul C. Jutte, and Jan A. P. Geurts
J. Bone Joint Infect., 6, 413–421, https://doi.org/10.5194/jbji-6-413-2021, https://doi.org/10.5194/jbji-6-413-2021, 2021
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Chronic osteomyelitis is a bone infection and was treated with a combination of antibiotics and two surgeries. With the introduction of the biomaterial S53P4 bioactive glass, these infections can be treated with antibiotics and one surgery. This study shows 85 % success in the treatment of these bone infections. Together with the fundamentally different antibacterial mechanisms without antibiotic resistance, S53P4 bioactive glass is recommendable for the treatment of these infections.
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
Related subject area
Subject: Prosthesis-related infections | Topic: Epidemiology
Sex-related differences in periprosthetic joint infection research
Characteristics and management of periprosthetic joint infections caused by rapidly growing mycobacteria: a retrospective study and a review of the literature
Sex-specific analysis of clinical features and outcomes in staphylococcal periprosthetic joint infections managed with two-stage exchange arthroplasty
Characteristics and outcomes of culture-negative prosthetic joint infections from the Prosthetic Joint Infection in Australia and New Zealand Observational (PIANO) cohort study
Has the time come for regional periprosthetic joint infection centers in the United States? A first-year experience
Domenico De Mauro, Cesare Meschini, Giovanni Balato, Tiziana Ascione, Enrico Festa, Davide Bizzoca, Biagio Moretti, Giulio Maccauro, and Raffaele Vitiello
J. Bone Joint Infect., 9, 137–142, https://doi.org/10.5194/jbji-9-137-2024, https://doi.org/10.5194/jbji-9-137-2024, 2024
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This study investigates sex-related differences in periprosthetic Joint Infections (PJIs) after total joint arthroplasty. A systematic review of nine studies reveals a higher risk of infectious complications in males compared to females, as indicated by statistically significant findings in half of the studies. This underscores the need for ongoing sex-related analysis to enhance evidence and insights in the field of PJIs.
Pansachee Damronglerd, Eibhlin Higgins, Madiha Fida, Don Bambino Geno Tai, Aaron J. Tande, Matthew P. Abdel, and Omar M. Abu Saleh
J. Bone Joint Infect., 9, 99–106, https://doi.org/10.5194/jbji-9-99-2024, https://doi.org/10.5194/jbji-9-99-2024, 2024
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This work investigates periprosthetic joint infection (PJI) caused by rapidly growing mycobacteria (RGM) following total joint arthroplasty. Eight patients were identified as part of a retrospective review. The isolated RGM species included Mycobacterium abscessus (three cases), M. fortuitum (three cases), and one case each of M. immunogenum and M. mageritense. We provide novel insights into the successful treatment of PJIs caused by newly identified RGM (M. immunogenum and M. mageritense).
Eibhlin Higgins, Don Bambino Geno Tai, Brian Lahr, Gina A. Suh, Elie F. Berbari, Kevin I. Perry, Matthew P. Abdel, and Aaron J. Tande
J. Bone Joint Infect., 8, 125–131, https://doi.org/10.5194/jbji-8-125-2023, https://doi.org/10.5194/jbji-8-125-2023, 2023
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This retrospective case-matched study evaluated males and females with staphylococcal PJI (periprosthetic joint infection) treated with two-stage exchange arthroplasty. We matched 156 males and females for age, type of staphylococcal infection, and joint involved. We compared clinical parameters related to presentation, treatment, and outcome. We did not find a statistically significant difference in outcome between males and females treated with the same surgical approach at our institution.
Sarah Browning, Laurens Manning, Sarah Metcalf, David L. Paterson, James O. Robinson, Benjamin Clark, and Joshua S. Davis
J. Bone Joint Infect., 7, 203–211, https://doi.org/10.5194/jbji-7-203-2022, https://doi.org/10.5194/jbji-7-203-2022, 2022
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Culture-negative (CN) prosthetic joint infections (PJIs) present significant challenges for clinicians. While previous retrospective analyses have been conducted, inconsistencies in inclusion criteria and treatment success measures limit the opportunity for direct comparisons and use in guiding clinical practice. We compared baseline characteristics and outcomes of CN with culture-positive (CP) cases in a large multicentre prospective cohort and demonstrated improved overall outcomes in CN PJI.
Murillo Adrados, Michael M. Valenzuela, Bryan D. Springer, Susan M. Odum, Thomas K. Fehring, and Jesse E. Otero
J. Bone Joint Infect., 7, 51–53, https://doi.org/10.5194/jbji-7-51-2022, https://doi.org/10.5194/jbji-7-51-2022, 2022
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Areas in orthopedics, such as spinal metastasis and sarcomas, have shown benefits of concentrated care in specialized centers. Currently in the US, no such centers exist for treatment of periprosthetic joint infection (PJI). We established a PJI center and review our first-year experience. Additionally, we note the complexity and volume of referrals, in addition to the abundant opportunities for research that referral centers provide. PJI centers are feasible and can improve PJI care.
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Short summary
This study validated three models for predicting infection after hip and knee replacement surgery. By analyzing data from 2684 patients in the Netherlands, Portugal, and Spain, we found that the models developed by Tan, Del Toro, and Bülow effectively identified high-risk patients. These models can be used to enhance preoperative counseling and to tailor infection prevention measures individually, potentially improving outcomes and reducing healthcare costs.
This study validated three models for predicting infection after hip and knee replacement...