Diagnosis of periprosthetic joint infection : Development of an evidence-based algorithm by the work group of implant-associated infection of the AE-(German Society for Arthroplasty)

• Published in: Der Orthopäde Vol. 50; no. 4; pp. 312 - 325
• Main Authors: Mühlhofer, H, Renz, N, Zahar, A, Lüdemann, M, Rudert, M, Hube, R, Frommelt, L, Ascherl, R, Perka, C, von Eisenhart-Rothe, R
• Format: Journal Article
• Language: German
• Published: Germany 01-04-2021
• Subjects: Algorithms; Arthritis, Infectious; Arthroplasty; Arthroplasty, Replacement, Hip - adverse effects; Humans; Predictive Value of Tests; Prosthesis-Related Infections - diagnosis; Prosthesis-Related Infections - etiology; Prosthesis-Related Infections - surgery; Reoperation; Biofilm; Sensitivity and specificity; Prosthesis-related infections; Joint prosthesis; Surgical diagnostic technic
• ISSN: 1433-0431
• DOI: 10.1007/s00132-020-03940-6

Prosthetic joint infections (PPI) will challenge orthopaedic surgeons and the health care system in the coming years. Evidence-based and reliable preoperative diagnostics are necessary for success in the field of revision arthroplasty. Especially the preoperative detection of PPI is important with respect to the treatment strategy.
The aim of this study was to develop a detailed and structured standard operating procedure (SOP) to detect PPI preoperatively.
A systematic literature research was performed and relevant articles identified. After extracting the data, statistical calculations of sensitivity, specificity, positive/negative predictive value and positive/negative likelihood ratio were performed. The results were discussed and evaluated in four meetings analogously to standard Delphi rounds by the workgroup of implant-associated infections of the German AE (Arbeitsgemeinschaft Endoprothetik). An algorithm for the diagnostic approach according to ISO 5807 was made.
The standardized algorithm combines a sequence of evidence-based procedures with detailed and structured main and additional criteria to every critical step in the diagnostic approach.
The detection of PPI is of tremendous importance prior to revision arthroplasty and determines its success or failure. The diagnosis "prosthetic joint infection" requires a substantial change with respect to treatment concepts. The algorithm summarizes current literature and specialized expert opinions in a modern standardized format for a transparent diagnostic approach.