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      The EBJIS definition of periprosthetic joint infection : a practical guide for clinicians

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          Abstract

          Aims

          The diagnosis of periprosthetic joint infection (PJI) can be difficult. All current diagnostic tests have problems with accuracy and interpretation of results. Many new tests have been proposed, but there is no consensus on the place of many of these in the diagnostic pathway. Previous attempts to develop a definition of PJI have not been universally accepted and there remains no reference standard definition.

          Methods

          This paper reports the outcome of a project developed by the European Bone and Joint Infection Society (EBJIS), and supported by the Musculoskeletal Infection Society (MSIS) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Implant-Associated Infections (ESGIAI). It comprised a comprehensive review of the literature, open discussion with Society members and conference delegates, and an expert panel assessment of the results to produce the final guidance.

          Results

          This process evolved a three-level approach to the diagnostic continuum, resulting in a definition set and guidance, which has been fully endorsed by EBJIS, MSIS, and ESGIAI.

          Conclusion

          The definition presents a novel three-level approach to diagnosis, based on the most robust evidence, which will be useful to clinicians in daily practice.

          Cite this article: Bone Joint J 2021;103-B(1):18–25.

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          Most cited references88

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          The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria

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            Prosthetic joint infection.

            Prosthetic joint infection (PJI) is a tremendous burden for individual patients as well as the global health care industry. While a small minority of joint arthroplasties will become infected, appropriate recognition and management are critical to preserve or restore adequate function and prevent excess morbidity. In this review, we describe the reported risk factors for and clinical manifestations of PJI. We discuss the pathogenesis of PJI and the numerous microorganisms that can cause this devastating infection. The recently proposed consensus definitions of PJI and approaches to accurate diagnosis are reviewed in detail. An overview of the treatment and prevention of this challenging condition is provided.
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              Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America.

              These guidelines are intended for use by infectious disease specialists, orthopedists, and other healthcare professionals who care for patients with prosthetic joint infection (PJI). They include evidence-based and opinion-based recommendations for the diagnosis and management of patients with PJI treated with debridement and retention of the prosthesis, resection arthroplasty with or without subsequent staged reimplantation, 1-stage reimplantation, and amputation.
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                Author and article information

                Contributors
                Role: EBJIS Past-President
                Role: EBJIS Executive Committee Member
                Role: ESGIAI Chair
                Role: Director of Research, Arthroplasty ServicesRole: Director of Research, Arthroplasty Services
                Role: EBJIS Vice-President, ESCMID FellowRole: Head of Infectious Diseases Department
                Role: EBJIS General SecretaryRole: Orthopaedic Surgeon
                Role: EBJIS TreasurerRole: Head of the Center for Musculoskeletal Infections
                Role: MSIS President
                Role: EBJIS PresidentRole: Head of Bone Infection
                Journal
                Bone Joint J
                Bone Joint J
                Bjj
                The Bone & Joint Journal
                The British Editorial Society of Bone & Joint Surgery (London )
                2049-4394
                2049-4408
                January 2021
                1 January 2021
                : 103-B
                : 1
                : 18-25
                Affiliations
                [1 ]org-divisionThe Bone Infection Unit, Nuffield Orthopaedic Centre , org-divisionOxford University Hospitals , Oxford, UK
                [2 ]org-divisionPorto Bone Infection Group (GRIP), Orthopaedic Department , org-divisionCentro Hospitalar Universitário do Porto , Porto, Portugal
                [3 ]org-divisionDepartment of Medical Microbiology and Infection Prevention , org-divisionUniversity of Groningen, University Medical Center Groningen , Groningen, Netherlands
                [4 ]org-divisionBrigham and Women’s Hospital , Boston, Massachusetts, USA
                [5 ]org-divisionHospital Clinic of Barcelona , Barcelona, Spain
                [6 ]org-divisionDepartment of Orthopaedics , org-divisionUniversity Medical Center Utrecht , Utrecht, Netherlands
                [7 ]org-divisionDepartment of Orthopaedics and Trauma Surgery , org-divisionUniversity Hospital Basel , Basel, Switzerland
                [8 ]org-divisionLevitetz Department of Orthopaedic Surgery , org-divisionCleveland Clinic , Florida, USA
                [9 ]org-divisionOrthopaedic Hospital Valdoltra , Ankaran, Slovenia
                Author notes
                Correspondence should be sent to Martin McNally. E-mail: martin.mcnally@ 123456ouh.nhs.uk
                Author information
                https://orcid.org/0000-0003-2003-9044
                https://orcid.org/0000-0003-4293-7347
                Article
                BJJ-103B-18
                10.1302/0301-620X.103B1.BJJ-2020-1381.R1
                7954183
                33380199
                fb0cdd43-667e-44a3-81d7-d4d03e97ac7e
                © 2021 Author(s) et al.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND 4.0) licence, which permits the copying and redistribution of the work only, and provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc-nd/4.0/

                History
                Categories
                Arthroplasty
                Return to Work
                Activity Level
                Revision Knee Arthroplasty
                Revision Hip Arthroplasty
                Custom metadata
                2.0
                $2.00
                The European Bone & Joint Infection Society, Rolle, Switzerland
                Arthroplasty
                M. McNally reports support for travel to meetings for the study (or other purposes) from the European Bone & Joint Society, which is related to this article, and royalties from Oxford University Press, which is unrelated. A. F. Chen declares royalties from SLACK Publishing and UpToDate, consultancy from Stryker, Pfizer, Convatec, 3M, Heraeus, DePuy-Ethicon, and GLG, consultancy and equity from bOne and Irrisept, equity from Joint Purification Systems, Sonoran Biosciences, Hyalex, and Graftworx, a grant from OREF, being a member of the advisory board for Hyalex, Recro, and being associate editor for The Journal of Bone and Joint Surgery, all of which are unrelated to to this artice. T. Clauss reports board membership for EBIS, which is unrelated. C. Higuera reports board membership for the Musculoskeletal Infection Society, consultancy from KCI, and grants/grants pending from Stryker, Zimmer Biomet, Orthofix, Ferring Pharmaceuticals, Lyfstone, CD Diagnostics, KCI, AAHKS, OREF, Cymedica and Aerobiotix, and stock/stock options from PSI, all of which are unrelated to this article. A. Soriano declares grants/grants pending and payment for lectures from Pfizer, and payment for lectures from Merck, Shionogi, and Menarini, all of which are unrelated. R. Trebše reports consultancy from Medacta, payment for lectures from Zimmer Biomet, and royalties from Springer Verlag, all of which are unrelated to this article.

                infection,arthroplasty,prosthetic joint infection,diagnosis,definition,ebjis

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