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      Consensus document for the diagnosis of prosthetic joint infections: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement)

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          Abstract

          Background

          For the diagnosis of prosthetic joint infection, real evidence-based guidelines to aid clinicians in choosing the most accurate diagnostic strategy are lacking.

          Aim and Methods

          To address this need, we performed a multidisciplinary systematic review of relevant nuclear medicine, radiological, orthopaedic, infectious, and microbiological literature to define the diagnostic accuracy of each diagnostic technique and to address and provide evidence-based answers on uniform statements for each topic that was found to be important to develop a commonly agreed upon diagnostic flowchart.

          Results and Conclusion

          The approach used to prepare this set of multidisciplinary guidelines was to define statements of interest and follow the procedure indicated by the Oxford Centre for Evidence-based Medicine (OCEBM).

          Electronic supplementary material

          The online version of this article (10.1007/s00259-019-4263-9) contains supplementary material, which is available to authorized users.

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          Sonication of removed hip and knee prostheses for diagnosis of infection.

          Andrej Trampuz, Kerryl E. Piper, Melissa Jacobson … (2007)
          Culturing of samples of periprosthetic tissue is the standard method used for the microbiologic diagnosis of prosthetic-joint infection, but this method is neither sensitive nor specific. In prosthetic-joint infection, microorganisms are typically present in a biofilm on the surface of the prosthesis. We hypothesized that culturing of samples obtained from the prosthesis would improve the microbiologic diagnosis of prosthetic-joint infection. We performed a prospective trial comparing culture of samples obtained by sonication of explanted hip and knee prostheses to dislodge adherent bacteria from the prosthesis with conventional culture of periprosthetic tissue for the microbiologic diagnosis of prosthetic-joint infection among patients undergoing hip or knee revision or resection arthroplasty. We studied 331 patients with total knee prostheses (207 patients) or hip prostheses (124 patients); 252 patients had aseptic failure, and 79 had prosthetic-joint infection. With the use of standardized nonmicrobiologic criteria to define prosthetic-joint infection, the sensitivities of periprosthetic-tissue and sonicate-fluid cultures were 60.8% and 78.5% (P<0.001), respectively, and the specificities were 99.2% and 98.8%, respectively. Fourteen cases of prosthetic-joint infection were detected by sonicate-fluid culture but not by prosthetic-tissue culture. In patients receiving antimicrobial therapy within 14 days before surgery, the sensitivities of periprosthetic tissue and sonicate-fluid culture were 45.0% and 75.0% (P<0.001), respectively. In this study, culture of samples obtained by sonication of prostheses was more sensitive than conventional periprosthetic-tissue culture for the microbiologic diagnosis of prosthetic hip and knee infection, especially in patients who had received antimicrobial therapy within 14 days before surgery. Copyright 2007 Massachusetts Medical Society.
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            Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002.

            Steven Kurtz, Fionna Mowat, Kevin Ong … (2005)
            The purpose of this study was to quantify the procedural rate and revision burden of total hip and knee arthroplasty in the United States and to determine if the age or gender-based procedural rates and overall revision burden are changing over time. The National Hospital Discharge Survey (NHDS) for 1990 through 2002 was used in conjunction with United States Census data to quantify the rates of primary and revision arthroplasty as a function of age and gender within the United States with use of methodology published by the American Academy of Orthopaedic Surgeons. Poisson regression analysis was used to evaluate the procedural rate and to determine year-to-year trends in primary and revision arthroplasty rates as a function of both age and gender. Both the number and the rate of total hip and knee arthroplasties (particularly knee arthroplasties) increased steadily between 1990 and 2002. Over the thirteen years, the rate of primary total hip arthroplasties per 100,000 persons increased by approximately 50%, whereas the corresponding rate of primary total knee arthroplasties almost tripled. The rate of revision total hip arthroplasties increased by 3.7 procedures per 100,000 persons per decade, and that of revision total knee arthroplasties, by 5.4 procedures per 100,000 persons per decade. However, the mean revision burden of 17.5% for total hip arthroplasty was more than twice that for total knee arthroplasty (8.2%), and this did not change substantially over time. The number and prevalence of primary hip and knee replacements increased substantially in the United States between 1990 and 2002, but the trend was considerably more pronounced for primary total knee arthroplasty. The reported prevalence trends have important ramifications with regard to the number of joint replacements expected to be performed by orthopaedic surgeons in the future. Because the revision burden has been relatively constant over time, we can expect that a greater number of primary replacements will result in a greater number of revisions unless some limiting mechanism can be successfully implemented to reduce the future revision burden.
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              Risk factors for prosthetic joint infection: case-control study.

              E F Berbari, A Hanssen, M Duffy … (1998)
              We conducted a matched case-control study to determine risk factors for the development of prosthetic joint infection. Cases were patients with prosthetic hip or knee joint infection. Controls were patients who underwent total hip or knee arthroplasty and did not develop prosthetic joint infection. A multiple logistic regression model indicated that risk factors for prosthetic joint infection were the development of a surgical site infection not involving the prosthesis (odds ratio [OR], 35.9; 95% confidence interval [CI], 8.3-154.6), a National Nosocomial Infections Surveillance (NNIS) System surgical patient risk index score of 1 (OR, 1.7; 95% CI, 1.2-2.3) or 2 (OR, 3.9; 95% CI, 2.0-7.5), the presence of a malignancy (OR, 3.1; 95% CI, 1.3-7.2), and a history of joint arthroplasty (OR, 2.0; 95% CI, 1.4-3.0). Our findings suggest that a surgical site infection not involving the joint prosthesis, an NNIS System surgical patient risk index score of 1 or 2, the presence of a malignancy, and a history of a joint arthroplasty are associated with an increased risk of prosthetic joint infection.
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                Author and article information

                Contributors
                Alberto Signore: alberto.signore@uniroma1.it
                Journal
                Journal ID (nlm-ta): Eur J Nucl Med Mol Imaging
                Journal ID (iso-abbrev): Eur. J. Nucl. Med. Mol. Imaging
                Title: European Journal of Nuclear Medicine and Molecular Imaging
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 1619-7070
                ISSN (Electronic): 1619-7089
                Publication date (Electronic): 26 January 2019
                Publication date PMC-release: 26 January 2019
                Publication date (Print): 2019
                Volume: 46
                Issue: 4
                Pages: 971-988
                Affiliations
                [1 ]GRID grid.7841.a, Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, , “Sapienza” University of Rome, ; Rome, Italy
                [2 ]GRID grid.417776.4, Unit of Diagnostic and Interventional Radiology, , IRCCS Istituto Ortopedico Galeazzi, ; Milan, Italy
                [3 ]ISNI 0000 0004 1757 2822, GRID grid.4708.b, Department of Biomedical Sciences for Health, , Università degli Studi di Milano, ; Milan, Italy
                [4 ]ISNI 0000 0001 0423 4662, GRID grid.8515.9, Division of Orthopaedic Surgery and Traumatology, , Lausanne University Hospital, ; Lausanne, Switzerland
                [5 ]ISNI 0000 0004 0407 1981, GRID grid.4830.f, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, , University of Groningen, ; Groningen, The Netherlands
                [6 ]Department of Diagnostic Imaging, The Robert Jones and Agnes Hunt Orthopaedic and District Hospital – Oswestry, Shropshire, UK
                [7 ]ISNI 0000 0001 2218 4662, GRID grid.6363.0, Department of Internal Medicine, , University Hospital “Charitè”, ; Berlin, Germany
                [8 ]Osteitis-Centre, Privatklinik Döbling, Vienna, Austria
                [9 ]ISNI 0000 0004 0626 3338, GRID grid.410569.f, Department of Nuclear Medicine, , University Hospital Leuven, ; Leuven, Belgium
                [10 ]ISNI 0000 0004 0626 3418, GRID grid.411414.5, Department of Radiology, , University Hospital Antwerp, AZ Sint-Maarten Duffel-Mechelen, and University of Ghent, ; Edegem, Belgium
                [11 ]Division of Infective Diseases, National Institute for Infective Diseases “L. Spallanzani”, Rome, Italy
                [12 ]ISNI 0000 0000 9558 4598, GRID grid.4494.d, Department of Orthopaedic Surgery, University of Groningen, , University Medical Center Groningen, ; Groningen, The Netherlands
                Author information
                http://orcid.org/0000-0001-8081-0641
                Article
                Publisher ID: 4263
                DOI: 10.1007/s00259-019-4263-9
                PMC ID: 6450843
                PubMed ID: 30683987
                SO-VID: 31273129-834a-4ba5-92d4-62189535dcaa
                Copyright © © The Author(s) 2019, corrected publication 2019
                License:

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Date received : 18 December 2018
                Date accepted : 2 January 2019
                Funding
                Funded by: University Medical Center Groningen (UMCG)
                Categories
                Subject: Guidelines
                Custom metadata
                issue-copyright-statement © Springer-Verlag GmbH Germany, part of Springer Nature 2019

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: infection diagnosis,prosthetic joint infection,imaging,guideline
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: infection diagnosis, prosthetic joint infection, imaging, guideline

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