How accurate are orthopedic surgeons in diagnosing periprosthetic joint infection after total knee arthroplasty?: A multicenter study

Abstract Background The lack of standardized diagnostic criteria for periprosthetic joint infection (PJI) poses a challenge to accurate diagnosis of PJI. Recently, the Musculoskeletal Infection Society (MSIS) proposed diagnostic criteria for PJI. However, it is not known how well these proposed crit...

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Bibliographic Details
Published in:The knee 2015-06, Vol.22 (3), p.180-185
Main Authors: Koh, In Jun, Cho, Woo-Shin, Choi, Nam Yong, Parvizi, Javad, Kim, Tae Kyun
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Arthritis
Arthroplasty, Replacement, Knee - adverse effects
Clinical Competence
Diagnostic criteria
Female
Follow-Up Studies
Hospitals
Humans
Joint surgery
Knee
Knee Prosthesis - adverse effects
Male
Middle Aged
Musculoskeletal Infection Society
Organisms
Orthopedics
Periprosthetic joint infection
Postoperative period
Prosthesis-Related Infections - diagnosis
Reproducibility of Results
Retrospective Studies
Staphylococcus infections
Surgeons - standards
Total knee arthroplasty
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Summary:Abstract Background The lack of standardized diagnostic criteria for periprosthetic joint infection (PJI) poses a challenge to accurate diagnosis of PJI. Recently, the Musculoskeletal Infection Society (MSIS) proposed diagnostic criteria for PJI. However, it is not known how well these proposed criteria accommodate real clinical scenarios. We determined what proportion of patients satisfied the MSIS criteria, and if MSIS criteria were not met, what other rationales were used to diagnose PJI. Methods We retrospectively reviewed the records of 303 patients who underwent two-stage exchange arthroplasty for treatment of PJI of the knee at 17 institutions. The rationale for making the diagnosis of PJI was also recorded, if the case did not meet the MSIS criteria. In addition, detailed information about isolated microorganisms were gathered. Results Among the 303 patients, 198 met the diagnostic criteria proposed by MSIS. Among the 105 patients who did not meet the MSIS criteria, 88% met two or three minor criteria; however joint fluid analysis or histologic analysis was not performed in 85% of these 105 patients. The most common rationale for the diagnosis of PJI was the presence of abnormal physical findings. Microorganisms were identified in only 52% of all patients; the most common organism was coagulase-negative Staphylococcus. Conclusions The diagnosis of PJI was based on clinical suspicion in approximately one-third of cases. In this series, joint aspiration or histological analysis was not performed in a large number of patients. Thus, surgeons should perform joint fluid and histologic analysis to assure the accuracy of PJI diagnosis.
ISSN:0968-0160
1873-5800
DOI:10.1016/j.knee.2015.02.004