Abstract
BackgroundThe aim of the present study was to evaluate the incidence of unsuspected PJI when prosthetic revisions are thoroughly evaluated by PJI dedicated orthopedic surgeon before surgery. The hypothesis is that the incidence of unsuspected PJI is reduced by applying this protocol.MethodsThis is a historical cohort study carried out in one university hospital. The prosthetic revision assessment was carried out in January 2019. From that date on, all patients that were programmed for hip or knee revision (either by an orthopedic surgeon specialized or not in septic revisions) were scheduled for a preoperative visit with the same orthopedic surgeon specialized in septic revisions. The diagnostic algorithm applied was based on the Pro-Implant Foundation diagnostic criteria. Prior to the revision assessment, the indication for joint aspiration was done at the surgeons’ discretion (non-specialized in septic revisions) and the preoperative identification of PJI was also done by a hip or knee surgeon (not specialized in septic surgery).ResultsBased on the PIF criteria, there were 15 infections among the revisions in group 1 and 18 PJI in group 2 (p > 0.05). The most interesting finding was that there were 7 patients with unsuspected positive cultures in group 1. That represents 11% of all revisions. No patient in group 2 was found with unsuspected positive cultures (p < 0.001).ConclusionA thorough PJI diagnostic algorithm should be implemented before prosthetic revision to avoid unsuspected positive cultures.
Highlights
The aim of the present study was to evaluate the incidence of unsuspected prosthetic joint infection (PJI) when prosthetic revisions are thoroughly evaluated by PJI dedicated orthopedic surgeon before surgery
The aim of the present study was to evaluate the incidence of unsuspected PJI when prosthetic revisions are thoroughly evaluated before surgery by PJI dedicated orthopedic surgeon
All patients that were programmed for hip or knee revision were scheduled for a preoperative visit with the same orthopedic surgeon specialized in septic surgery (DPP)
Summary
The aim of the present study was to evaluate the incidence of unsuspected PJI when prosthetic revisions are thoroughly evaluated by PJI dedicated orthopedic surgeon before surgery. According to the reports published in the last decades, prosthetic joint infection (PJI) is one of the most dreaded complications among orthopedic surgeons [1,2,3]. The reason for this fear is multifactorial. The burden of PJI in developing countries is rising and the costs are among the highest in orthopedic procedures [4,5,6,7] Another cause is the poor results published in some studies in which the success rate is lower than 50% [8]. Some orthopedic surgeons just look the other way and do not look pro-actively to find and diagnose this complication
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