Abstract
Purpose Contradicting definitions of periprosthetic joint infection (PJI) are in use. Joint aspiration is performed before total hip arthroplasty (THA) revision. This study investigated the influence of PJI definition on PJI prevalence at THA revision. Test quality of prerevision aspiration was evaluated for the different PJI definitions. Methods 256 THA revisions were retrospectively classified to be infected or not infected. Classification was performed according to the 4 different definitions proposed by the Musculoskeletal Infection Society (MSIS), the Infectious Diseases Society of America (IDSA), the International Consensus Meeting (ICM), and the European Bone and Joint Infection Society (EBJIS). Only chronic PJIs were included. Results PJI prevalence at revision significantly correlated with the applied PJI definition (p = 0.01, Cramer's V = 0.093). PJI prevalence was 20.7% for the MSIS, 25.4% for the ICM, 28.1% for the IDSA, and 32.0% for the EBJIS definition. For synovial fluid white blood cell count, the best ROC-AUC for predicting PJI was 0.953 in combination with the MSIS definition. Conclusion PJI definition significantly influences the rate of diagnosed PJIs at THA revision. Synovial fluid white blood cell count is a reliable means to rule out PJI. In cases with a borderline high synovial white blood cell count before THA revision as the only sign of chronic PJI, an extended diagnostic work-up should be considered.
Highlights
Periprosthetic joint infection (PJI) has become a rare complication in primary total hip arthroplasty (THA), occurring in 0.2% to 2.0% [1, 2]
This study investigated the influence of periprosthetic joint infection (PJI) definition on PJI prevalence at THA revision
Classification was performed according to the 4 different definitions proposed by the Musculoskeletal Infection Society (MSIS), the Infectious Diseases Society of America (IDSA), the International Consensus Meeting (ICM), and the European Bone and Joint Infection Society (EBJIS)
Summary
Periprosthetic joint infection (PJI) has become a rare complication in primary total hip arthroplasty (THA), occurring in 0.2% to 2.0% [1, 2]. The Musculoskeletal Infection Society (MSIS) was the first to publish a standard for the definition of PJI in 2011. This definition inaugurated the major criteria of PJI, which were the presence of a sinus tract or repeated pathogen isolation from the periprosthetic surrounding [5]. This definition was followed by a guideline published by the Infectious Diseases Society of America (IDSA) in 2012. Diagnostic algorithms advocate prerevision aspiration to exclude chronic PJI as an unrecognized cause of THA failure before revision [9,10,11]
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