gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019)

22. - 25.10.2019, Berlin

Single-center validation of the 2018 ICM criteria for hip and knee PJI

Meeting Abstract

  • presenting/speaker Eduardo Suero - Department of General, Trauma and Reconstructive Surgery, University Hospital Munich LMU, Munich, Germany
  • Hussein Abdelaziz - Helios Endoklinik, Hamburg, Germany
  • Kristof Rademacher - ENDO-Klinik Hamburg, Hamburg, Germany
  • Thorsten Gehrke - HELIOS Endo-Klinik Hamburg GmbH, Gelenkchirurgie, Hamburg, Germany
  • Mustafa Citak - Helios ENDO-Klinik Hamburg, Gelenkchirurgie, Hamburg, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2019). Berlin, 22.-25.10.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocAB37-1409

doi: 10.3205/19dkou268, urn:nbn:de:0183-19dkou2685

Veröffentlicht: 22. Oktober 2019

© 2019 Suero et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Objectives: The consequences of periprosthetic joint infection (PJI) may be catastrophic in some situations, but an early accurate diagnosis leads to a tremendous improvement in outcome. As clinical symptoms and signs are non-specific in many cases, a diagnosis of PJI can be only established following preoperative blood and joint tests, as well as intra- and postoperative investigations. To conclude whether the joint is infected or not, the interpretation of various preoperative and intraoperative diagnostics should be considered. The defined criteria by the Musculoskeletal Infection Society (MSIS), which were slightly modified at the 1st International Consensus Meeting (ICM), have facilitated the diagnosis of PJI considerably. However, due to accumulated different experiences in the last years and the introduction of promising new markers and tests in this field, further modifications have been required. Parvizi et al. developed an evidence-based scoring system in their recent multi-institutional study to define PJI of the hip and knee. Despite a reported sensitivity of 97.7% using this scoring system compared to 79.3% for MSIS and 86.9% for the 1st ICM criteria, only 68% of the delegates of the 2nd ICM voted for the new modified definition, resulting in a weak consensus.

We aimed to test and validate the minor criteria of the proposed scoring system for PJI following total hip arthroplasty (THA) and total knee arthroplasty (TKA).

Methods: We retrospectively reviewed the records of patients who underwent a revision THA (n=134) and TKA (n=210) at our high-volume arthroplasty center from May 2015 to September 2018. Preoperatively, the serum C-reactive protein was determined and the index joint was aspirated. In addition, we obtained for all patients: the white blood cell (WBC) count, the percentage of polymorphonuclear (PMN) WBC, the presence of leukocyte esterase (LE) and the Alpha-defensin. Intraoperatively, at least two periprosthetic tissue samples and another sample were sent to the microbiological and histological examination. A preoperative existence of sinus tract or not, and an intraoperative presence of purulence or not was always documented. Using as gold standard for a diagnosis of PJI the 2013 ICM criteria, we analyzed the diagnostic performance of the 2018 ICM minor criteria for identifying infected joints.

Results and conclusion: For the diagnosis of PJI, a cutoff score >= 6 points in the 2018 ICM Minor Criteria had the following diagnostic performance: AUC=0.85; Sensitivity=0.84; Specificity=0.86; LR+=6.04; LR-=0.18; PPV=0.76; NPV=0.91; False pos.=32; False neg.=19). Diagnostic performance was better for the hip (AUC=0.90; Sensitivity=0.90; Specificity=0.90) than for the knee (AUC=0.82; Sensitivity=0.80; Specificity=0.84).

This is the first study aimed at validating the 2018 ICM Criteria for PJI in a high-volume German arthroplasty center. We have demonstrated the validity of the minor criteria in detecting PJI, with high performance as both rule-out and rule-in diagnostic criteria.