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.
Original full-length article
| 
25 Oct 2024
Original full-length article |
| 25 Oct 2024
| 25 Oct 2024
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
No articles found.
Graham S. Goh, Elise R. Naufal, Michelle M. Dowsey, Sina Babazadeh, Jesse E. Otero, Carlos A. Higuera-Rueda, Marjan Wouthuyzen-Bakker, and Orthopaedic Device Infection Network (ODIN)
J. Bone Joint Infect., 10, 553–559, https://doi.org/10.5194/jbji-10-553-2025, https://doi.org/10.5194/jbji-10-553-2025, 2025
Short summary
Short summary
A multi-center study of 563 periprosthetic joint infections (PJIs) found that 16.5 % were culture negative. These patients more often had prior revision or PJI, longer symptom duration and fewer systemic signs. On multivariable analysis, symptom duration >12 weeks was the only independent risk factor (odds ratio 2.24). The findings support the fact that culture-negative infections present insidiously, informing diagnostic strategies.
Benjamin R. Paul, David G. Deckey, Alex Soriano, Andy Miller, and Thorsten M. Seyler
J. Bone Joint Infect., 10, 525–541, https://doi.org/10.5194/jbji-10-525-2025, https://doi.org/10.5194/jbji-10-525-2025, 2025
Short summary
Short summary
A total of 51 studies were reviewed to compare the alpha-defensin enzyme-linked immunosorbent assay (ELISA) and the lateral flow test for diagnosing joint replacement infections. Both tests are highly specific and accurately confirm infection, but ELISA showed greater sensitivity (87.8 % vs. 81.8 %), making it better for detection. These findings support the continued use of ELISA as the preferred diagnostic method.
Laura Bessems, Jolien Onsea, Baixing Chen, Marjan Wouthuyzen-Bakker, Irene K. Sigmund, Tristan Ferry, Richard Kuehl, Martin Clauss, Alex Soriano, Ricardo Sousa, Annette Schuermans, and Willem-Jan Metsemakers
J. Bone Joint Infect., 10, 489–500, https://doi.org/10.5194/jbji-10-489-2025, https://doi.org/10.5194/jbji-10-489-2025, 2025
Short summary
Short summary
Isolation of patients with musculoskeletal infections in orthopedic care is controversial. Evidence supports selective isolation for certain resistant pathogens but not for non-resistant pathogens, nor does it support the routine use of septic wards. Effective infection control depends on hospital-wide strategies and adherence to standard precautions, with specialized centres offering better care than dedicated isolation units.
Joana Contente, Carlos Ferreira, Mário Silva, Guilherme Madeira, Ana Ribau, and Ricardo Sousa
J. Bone Joint Infect., 10, 403–410, https://doi.org/10.5194/jbji-10-403-2025, https://doi.org/10.5194/jbji-10-403-2025, 2025
Short summary
Short summary
We assessed whether two debated scoring tools, KLIC and CRIME-80, could predict the failure of a treatment called debridement, antibiotics, and implant retention (DAIR) in prosthetic joint infections. We reviewed data from 102 patients. Neither score reliably predicted failure, even when the treatment was repeated. Our results highlight the limited clinical utility of these scores and support the need for better tools to guide treatment decisions in joint infections.
Marta Sabater-Martos, Laura Morata, Josep Maria Segur, Alex Soriano, and Juan Carlos Martínez-Pastor
J. Bone Joint Infect., 10, 237–241, https://doi.org/10.5194/jbji-10-237-2025, https://doi.org/10.5194/jbji-10-237-2025, 2025
Short summary
Short summary
This study's aim was to analyse the healing and failure rates of one-stage knee replacement in patients with positive and negative preoperative cultures and sinus presence. We concluded that culture-negative infections or the presence of a sinus tract showed similar results compared to patients that had undergone the same procedure with positive cultures or spared soft tissue.
Hendrika M. Schenk, Marine Sebillotte, Jose Lomas, Adrian Taylor, Eva Benavent, Oscar Murillo, Marta Fernandez-Sampedro, Kaisa Huotari, Craig Aboltins, Rihard Trebse, Alex Soriano, Marjan Wouthuyzen-Bakker, and on behalf of the ESCMID Study Group on Implant Associated Infections (ESGIAI)
J. Bone Joint Infect., 10, 217–224, https://doi.org/10.5194/jbji-10-217-2025, https://doi.org/10.5194/jbji-10-217-2025, 2025
Short summary
Short summary
Patients with rheumatoid arthritis have a high treatment failure rate when faced with a late acute periprosthetic joint infection. Because of the rarity of the condition, we performed a multicenter case-control study. We identified predictors of treatment failure to ultimately improve the treatment outcome. Exchange of modular components seems important in this patient group, likely due to a higher rate of positive blood cultures compared to control patients.
Marta Sabater-Martos, Martin Clauss, Ana Ribau, Ricardo Sousa, and on behalf of the Leukocyte Count Synovial Fluid working group for the Unified PJI definition task force
J. Bone Joint Infect., 10, 165–184, https://doi.org/10.5194/jbji-10-165-2025, https://doi.org/10.5194/jbji-10-165-2025, 2025
Short summary
Short summary
This meta-analysis evaluates synovial fluid white blood cell count and polymorphonuclear neutrophil proportion in order to diagnose chronic peri-prosthetic joint infection. Based on 74 studies, it identifies optimal thresholds, with rule-in and rule-out thresholds enhancing diagnostic precision. Confounding factors such as fractures and inflammatory arthritis are addressed. The findings support standardized diagnostic frameworks in improving accuracy and clinical consistency.
Irene K. Sigmund, Marjan Wouthuyzen-Bakker, Tristan Ferry, Willem-Jan Metsemakers, Martin Clauss, Alex Soriano, Rihard Trebse, and Ricardo Sousa
J. Bone Joint Infect., 10, 139–142, https://doi.org/10.5194/jbji-10-139-2025, https://doi.org/10.5194/jbji-10-139-2025, 2025
Short summary
Short summary
This is a summary of our position paper on debridement, antimicrobial therapy, and implant retention (DAIR) procedures as a curative treatment strategy for acute periprosthetic hip and knee infections. It includes the defined indications as well as the contraindications of DAIR procedures when eradication/cure is intended, based on the currently available literature.
Irene K. Sigmund, Tristan Ferry, Ricardo Sousa, Alex Soriano, Willem-Jan Metsemakers, Martin Clauss, Rihard Trebse, and Marjan Wouthuyzen-Bakker
J. Bone Joint Infect., 10, 101–138, https://doi.org/10.5194/jbji-10-101-2025, https://doi.org/10.5194/jbji-10-101-2025, 2025
Short summary
Short summary
In this paper, we discuss the most relevant factors influencing the outcome and define indications, contraindications, and risk factors of a DAIR procedure based on the currently available literature. Furthermore, we discuss the surgical technique in combination with systemic antimicrobial therapy in patients undergoing a DAIR procedure.
Sebastian Simon, Marjan Wouthuyzen-Bakker, Susana Gardete Hartmann, Jennyfer A. Mitterer, Sujeesh Sebastian, Stephanie Huber, Bernhard J. H. Frank, and Jochen G. Hofstaetter
J. Bone Joint Infect., 10, 51–59, https://doi.org/10.5194/jbji-10-51-2025, https://doi.org/10.5194/jbji-10-51-2025, 2025
Short summary
Short summary
We compared the re-revision rates in rTHA and rTKA (revison total hip and knee arthroplasty) with and without AB (antibiotic) treatment in patients with UPICs (unexpected positive intraoperative cultures). The re-revision rate between the AB group and the non-AB group was similar. Postoperative AB treatment did not result in a decreased re-revision rate in patients with UPICs in presumed aseptic rTHA and rTKA. Patients with pathogens classified as a likely contaminant can be safely ignored.
Marta Sabater-Martos, Oscar Garcia, Laia Boadas, Laura Morata, Alex Soriano, and Juan Carlos Martínez-Pastor
J. Bone Joint Infect., 10, 41–49, https://doi.org/10.5194/jbji-10-41-2025, https://doi.org/10.5194/jbji-10-41-2025, 2025
Short summary
Short summary
This is a retrospective diagnostic study in acute postoperative prosthetic joint infection in total knee arthroplasty that wants to determine diagnostic accuracy of synovial glucose and serum-to-synovial glucose ratio in acute postoperative infection. Both tests demonstrated good diagnostic potential. Notably, these biomarkers exhibited superior accuracy compared to the combination of C-reactive protein, synovial white blood cell count and polymorphonuclear percentage.
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
Short summary
Short summary
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
Short summary
Short summary
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
Short summary
Short summary
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
Short summary
Short summary
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
Short summary
Short summary
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
Short summary
Short summary
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
Short summary
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.
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
Short summary
Short summary
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
Short summary
Short summary
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
Short summary
Short summary
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
Short summary
Short summary
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
Short summary
Short summary
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
Short summary
Short summary
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
Short summary
Short summary
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
Short summary
Short summary
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.
Cited articles
Al-Houraibi, R. K., Aalirezaie, A., Adib, F., Anoushiravani, A., Bhashyam, A., Binlaksar, R., Blevins, K., Bonanzinga, T., Chih-Kuo, F., Cordova, M., Deirmengian, G. K., Fillingham, Y., Frenkel, T., Gomez, J., Gundtoft, P., Harris, M. A., Harris, M., Heller, S., Jennings, J. A., Jiménez-Garrido, C., Karam, J. A., Khlopas, A., Klement, M. R., Komnos, G., Krebs, V., Lachiewicz, P., Miller, A. O., Mont, M. A., Montañez, E., Romero, C. A., Schwarzkopf, R., Shaffer, A., Sharkey, P. F., Smith, B. M., Sodhi, N., Thienpont, E., Villanueva, A. O., and Yazdi, H.: General Assembly, Prevention, Wound Management: Proceedings of International Consensus on Orthopedic Infections, J. Arthroplasty, 34, S157–S168, https://doi.org/10.1016/j.arth.2018.09.066, 2019.
Bilimoria, K. Y., Liu, Y., Paruch, J. L., Zhou, L., Kmiecik, T. E., Ko, C. Y., and Cohen, M. E.: Development and evaluation of the universal ACS NSQIP surgical risk calculator: a decision aid and informed consent tool for patients and surgeons, J. Am. Coll. Surg., 217, 833–842e3, https://doi.org/10.1016/j.jamcollsurg.2013.07.385, 2013.
Bourne, R. B., Maloney, W. J., and Wright, J. G.: An AOA critical issue. The outcome of the outcomes movement, J. Bone Joint Surg. Am., 86, 633–640, https://doi.org/10.2106/00004623-200403000-00026, 2004.
Bülow, E., Hahn, U., Andersen, I. T., Rolfson, O., Pedersen, A. B., and Hailer, N. P.: Prediction of early periprosthetic joint infection after total hip arthroplasty, Clin. Epidemiol., 14, 239–253, https://doi.org/10.2147/CLEP.S347968, 2022.
Cahill, J. L., Shadbolt, B., Scarvell, J. M., and Smith, P. N.: Quality of life after infection in total joint replacement, J. Orthop. Surg. (Hong Kong), 16, 58–65, https://doi.org/10.1177/230949900801600115, 2008.
Charlson, M. E., Pompei, P., Ales, K. L., and MacKenzie, C. R.: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation, J. Chronic Dis., 40, 373–383, https://doi.org/10.1016/0021-9681(87)90171-8, 1987.
Collins, G. S., Reitsma, J. B., Altman, D. G., and Moons, K. G.: Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement, Brit. Med. J., 350, g7594, https://doi.org/10.1136/bmj.g7594, 2015.
Dale, H., Fenstad, A. M., Hallan, G., Havelin, L. I., Furnes, O., Overgaard, S., Pedersen, A. B., Källholm, J., Garellick, G., Pulkkinen, P., Eskelinen, A., Mäkelä, K., and Engesæter, L. B.: Increasing risk of prosthetic joint infection after total hip arthroplasty, Acta Orthop., 83, 449–458, https://doi.org/10.3109/17453674.2012.733918, 2012.
De Cock, B., Nieboer, D., Van Calster, B., Steyerberg, E. W., and Vergouwe, Y.: The CalibrationCurves package: validating predicted probabilities against binary events, Zenodo [code], https://doi.org/10.5281/zenodo.7801542, 2023.
Del Toro, M. D., Peñas, C., Conde-Albarracín, A., Palomino, J., Brun, F., Sánchez, S., and Rodríguez-Baño, J.: Development and validation of baseline, perioperative and at-discharge predictive models for postsurgical prosthetic joint infection, Clin. Microbiol. Infect., 25, 196–202, https://doi.org/10.1016/j.cmi.2018.04.023, 2019.
Edelstein, A. I., Kwasny, M. J., Suleiman, L. I., Khakhkhar, R. H., Moore, M. A., Beal, M. D., and Manning, D. W.: Can the American College of Surgeons Risk Calculator predict 30-day complications after knee and hip arthroplasty?, J. Arthroplasty, 30, 5–10, https://doi.org/10.1016/j.arth.2015.01.057, 2015.
Elixhauser, A., Steiner, C., Harris, D. R., and Coffey, R. M.: Comorbidity measures for use with administrative data, Med. Care, 36, 8–27, https://doi.org/10.1097/00005650-199801000-00004, 1998.
Espindola, R., Vella, V., Benito, N., Mur, I., Tedeschi, S., Rossi, N., Hendriks, J. G. E., Sorlí, L., Murillo, O., Scarborough, M., Scarborough, C., Kluytmans, J., Ferrari, M. C., Pletz, M. W., McNamara, I., Escudero-Sanchez, R., Arvieux, C., Batailler, C., Dauchy, F. A., Liu, W. Y., Lora-Tamayo, J., Praena, J., Ustianowski, A., Cinconze, E., Pellegrini, M., Bagnoli, F., Rodríguez-Baño, J., and Del Toro, M. D.; ARTHR-IS group: Preoperative and perioperative risk factors, and risk score development for prosthetic joint infection due to Staphylococcus aureus: a multinational matched case-control study, Clin. Microbiol. Infect., 28, 1359–1366, https://doi.org/10.1016/j.cmi.2022.05.010, 2022.
Franklin, P. D., Miozzari, H., Christofilopoulos, P., Hoffmeyer, P., Ayers, D. C., and Lübbeke, A.: Important patient characteristics differ prior to total knee arthroplasty and total hip arthroplasty between Switzerland and the United States, BMC Musculoskelet. Disord., 18, 14, https://doi.org/10.1186/s12891-016-1372-5, 2017.
Goltz, D. E., Baumgartner, B. T., Politzer, C. S., DiLallo, M., Bolognesi, M. P., and Seyler, T. M.: The American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator has a role in predicting discharge to post-acute care in total joint arthroplasty, J. Arthroplasty, 33, 25–29, https://doi.org/10.1016/j.arth.2017.08.008, 2018.
Gromov, K., Greene, M. E., Sillesen, N. H., Troelsen, A., Malchau, H., Huddleston, J. I., Emerson, R., Garcia-Cimbrelo, E., and Gebuhr, P.; Multicenter Writing Committee: Regional differences between US and Europe in radiological osteoarthritis and self-assessed quality of life in patients undergoing total hip arthroplasty surgery, J. Arthroplasty, 29, 2078–2083, https://doi.org/10.1016/j.arth.2014.07.006, 2014.
Hackett, D. J., Rothenberg, A. C., Chen, A. F., Gutowski, C., Jaekel, D., Tomek, I. M., Parsley, B. S., Ducheyne, P., and Manner, P. A.: The economic significance of orthopaedic infections, J. Am. Acad. Orthop. Surg., 23, S1–S7, https://doi.org/10.5435/JAAOS-D-14-00394, 2015.
Harrell, F. E. Jr., Lee, K. L., and Mark, D. B.: Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors, Stat. Med., 15, 361–387, https://doi.org/10.1002/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4, 1996.
Iannotti, F., Prati, P., Fidanza, A., Iorio, R., Ferretti, A., Pérez Prieto, D., Kort, N., Violante, B., Pipino, G., Schiavone Panni, A., Hirschmann, M., Mugnaini, M., and Indelli, F.: Prevention of periprosthetic joint infection (PJI): A clinical practice protocol in high-risk patients, Trop. Med. Infect. Dis., 5, 186, https://doi.org/10.3390/tropicalmed5040186, 2020.
Jenny, J. Y., Hamon, M., Klein, S., Reiter-Schatz, A., Rondé-Oustau, C., Boéri, C., Wisniewski, S., and Gaudias, J.: Cement loaded with high-dose gentamicin and clindamycin reduces the risk of subsequent infection after one-stage hip or knee arthroplasty exchange for periprosthetic infection: a preliminary study, J. Arthroplasty, 36, 3973–3978, https://doi.org/10.1016/j.arth.2021.08.014, 2021.
Klemt, C., Yeo, I., Harvey, M., Burns, J. C., Melnic, C., Uzosike, A. C., and Kwon, Y. M.: The use of artificial intelligence for the prediction of periprosthetic joint infection following aseptic revision total knee arthroplasty, J. Knee Surg., 37, 158–166, https://doi.org/10.1055/s-0043-1761259, 2023.
Kunutsor, S. K., Whitehouse, M. R., Blom, A. W., and Beswick, A. D.: Systematic review of risk prediction scores for surgical site infection or periprosthetic joint infection following joint arthroplasty, Epidemiol. Infect., 145, 1738–1749, https://doi.org/10.1017/S0950268817000486, 2017.
Kurtz, S. M., Lau, E., Schmier, J., Ong, K. L., Zhao, K., and Parvizi, J.: Infection burden for hip and knee arthroplasty in the United States, J. Arthroplasty, 23, 984–991, https://doi.org/10.1016/j.arth.2007.10.017, 2008.
McNally, M., Sousa, R., Wouthuyzen-Bakker, M., Chen, A. F., Soriano, A., Vogely, H. C., Clauss, M., Higuera, C. A., and Trebše, R.: The EBJIS definition of periprosthetic joint infection, Bone Joint J., 103-B, 18–25, https://doi.org/10.1302/0301-620X.103B1.BJJ-2020-1381.R1, 2021.
Merrill, R. K., Ibrahim, J. M., Machi, A. S., and Raphael, J. S.: Analysis and review of automated risk calculators used to predict postoperative complications after orthopedic surgery, Curr. Rev. Musculoskelet. Med., 13, 298–308, https://doi.org/10.1007/s12178-020-09632-0, 2020.
Paxton, E. W., Cafri, G., Nemes, S., Lorimer, M., Källholm, J., Malchau, H., Graves, S. E., Namba, R. S., and Rolfson, O.: An international comparison of THA patients, implants, techniques, and survivorship in Sweden, Australia, and the United States, Acta Orthop., 90, 148–152, https://doi.org/10.1080/17453674.2019.1574395, 2019.
Premkumar, A., Kolin, D. A., Farley, K. X., Wilson, J. M., McLawhorn, A. S., Cross, M. B., and Sculco, P. K.: Projected economic burden of periprosthetic joint infection of the hip and knee in the United States, J. Arthroplasty, 36, P1484–1489.E3, https://doi.org/10.1016/j.arth.2020.12.005, 2021.
Royston, P. and Altman, D. G.: Visualizing and assessing discrimination in the logistic regression model, Stat. Med., 29, 2508–2520, https://doi.org/10.1002/sim.3994, 2010.
Steyerberg, E. W., Vickers, A. J., Cook, N. R., Gerds, T., Gonen, M., Obuchowski, N., Pencina, M. J., and Kattan, M. W.: Assessing the performance of prediction models: a framework for traditional and novel measures, Epidemiology, 21, 128–138, https://doi.org/10.1097/EDE.0b013e3181c30fb2, 2010.
Sweerts, L., Hoogeboom, T. J., van Wessel, T., van der Wees, P. J., and van de Groes, S. A. W.: Development of prediction models for complications after primary total hip and knee arthroplasty: a single-centre retrospective cohort study in the Netherlands, BMJ Open, 12, e062065, https://doi.org/10.1136/bmjopen-2022-062065, 2022.
Sweerts, L., Dekkers, P. W., van der Wees, P. J., van Susante, J. L. C., de Jong, L. D., Hoogeboom, T. J., and van de Groes, S. A. W.: External validation of prediction models for surgical complications in people considering total hip or knee arthroplasty was successful for delirium but not for surgical site infection, postoperative bleeding, and nerve damage: a retrospective cohort study, J. Pers. Med., 13, 277, https://doi.org/10.3390/jpm13020277, 2023.
Tan, T. L., Maltenfort, M. G., Chen, A. F., Shahi, A., Higuera, C. A., Siqueira, M., and Parvizi, J.: Development and evaluation of a preoperative risk calculator for periprosthetic joint infection following total joint arthroplasty, J. Bone Joint Surg. Am., 100, 777–785, https://doi.org/10.2106/JBJS.16.01435, 2018.
Van Buuren, S. and Groothuis-Oudshoorn, K.: mice: Multivariate imputation by chained equations in R, J. Stat. Softw. [code], https://doi.org/10.18637/jss.v045.i03, 2011.
Van Calster, B., Nieboer, D., Vergouwe, Y., De Cock, B., Pencina, M. J., and Steyerberg, E. W.: A calibration hierarchy for risk models was defined: from utopia to empirical data, J. Clin. Epidemiol., 74, 167–176, https://doi.org/10.1016/j.jclinepi.2015.12.005, 2016.
Van Calster, B., Steyerberg, E. W., Wynants, L., and van Smeden, M.: There is no such thing as a validated prediction model, BMC Med., 21, 70, https://doi.org/10.1186/s12916-023-02779-w, 2023.
White, I. R., Royston, P., and Wood, A. M.: Multiple imputation using chained equations: issues and guidance for practice, Stat. Med. [code], https://doi.org/10.1002/sim.4067, 2011.
Wickham, H., François, R., Henry, L., Müller, K., and Vaughan, D.: dplyr: A Grammar of Data Manipulation, Zenodo [code], https://doi.org/10.5281/zenodo.7902995, 2023.
Wingert, N. C., Gotoff, J., Parrilla, E., Gotoff, R., Hou, L., and Ghanem, E.: The ACS NSQIP risk calculator is a fair predictor of acute periprosthetic joint infection, Clin. Orthop. Relat. Res., 474, 1643–1648, https://doi.org/10.1007/s11999-016-4717-3, 2016.
Xu, C., Tan, T. L., Li, W. T., Goswami, K., and Parvizi, J.: Reporting outcomes of treatment for periprosthetic joint infection of the knee and hip together with a minimum 1-year follow-up is reliable, J. Arthroplasty, 35, P1906–1911.E5, https://doi.org/10.1016/j.arth.2020.02.017, 2020.
Yeo, I., Klemt, C., Robinson, M. G., Esposito, J. G., Uzosike, A. C., and Kwon, Y. M.: The use of artificial neural networks for the prediction of surgical site infection following TKA, J. Knee Surg., 36, 637–643, https://doi.org/10.1055/s-0041-1741396, 2023.
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...
