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How accurate are orthopedic surgeons in diagnosing periprosthetic joint infection after total knee arthroplasty?: A
In Jun Koh1, Woo-Shin Cho2, Nam Yong Choi3
1Department of Orthopaedics, Seoul St. Mary's Hospital, Seoul 137-701, Republic of Korea; Department of Orthopaedics, The Catholic University of Korea, College of Medicine, Seoul 137-701, Republic of Korea.
Background:
The lack of standardized diagnostic criteria for periprosthetic joint infection (PJI) poses a challenge to accurate diagnosis of PJI. Recently, the Musculoskeletal Infection Society (MSIS) proposed diagnostic criteria for PJI. However, it is not known how well these proposed criteria accommodate real clinical scenarios. We determined what proportion of patients satisfied the MSIS criteria, and if MSIS criteria were not met, what other rationales were used to diagnose PJI.
Methods:
We retrospectively reviewed the records of 303 patients who underwent two-stage exchange arthroplasty for treatment of PJI of the knee at 17 institutions. The rationale for making the diagnosis of PJI was also recorded, if the case did not meet the MSIS criteria. In addition, detailed information about isolated microorganisms were gathered.
Results:
Among the 303 patients, 198 met the diagnostic criteria proposed by MSIS. Among the 105 patients who did not meet the MSIS criteria, 88% met two or three minor criteria; however joint fluid analysis or histologic analysis was not performed in 85% of these 105 patients. The most common rationale for the diagnosis of PJI was the presence of abnormal physical findings. Microorganisms were identified in only 52% of all patients; the most common organism was coagulase-negative Staphylococcus.
Conclusions:
The diagnosis of PJI was based on clinical suspicion in approximately one-third of cases. In this series, joint aspiration or histological analysis was not performed in a large number of patients. Thus, surgeons should perform joint fluid and histologic analysis to assure the accuracy of PJI diagnosis.
Insights
The Musculoskeletal Infection Society (MSIS) criteria for periprosthetic joint infection (PJI) were met by only two-thirds of patients. Clinical suspicion often led to PJI diagnosis when criteria were not met, highlighting the need for joint fluid analysis.
Area of Science:
- Orthopedics
- Infectious Diseases
- Medical Diagnostics
Background:
- Standardized diagnostic criteria for periprosthetic joint infection (PJI) are lacking, complicating accurate diagnosis.
- The Musculoskeletal Infection Society (MSIS) recently proposed new diagnostic criteria for PJI.
- The clinical utility and applicability of the MSIS criteria in real-world scenarios remain unclear.
Purpose of the Study:
- To evaluate the proportion of patients meeting the proposed MSIS diagnostic criteria for PJI.
- To identify the diagnostic rationales used when MSIS criteria were not met.
- To analyze the microorganisms identified in patients with PJI.
Main Methods:
- Retrospective review of 303 patients undergoing two-stage exchange arthroplasty for knee PJI across 17 institutions.
- Recording the rationale for PJI diagnosis in cases not meeting MSIS criteria.
- Gathering data on isolated microorganisms.
Main Results:
- 198 out of 303 patients (65%) met the MSIS diagnostic criteria for PJI.
- Of the 105 patients not meeting MSIS criteria, 88% met 2-3 minor criteria, but joint fluid or histologic analysis was absent in 85%.
- Abnormal physical findings were the most common reason for PJI diagnosis; coagulase-negative Staphylococcus was the most frequent microorganism identified (52% of cases).
Conclusions:
- Periprosthetic joint infection diagnosis relied on clinical suspicion in approximately one-third of cases.
- Joint aspiration and histological analysis were frequently omitted, potentially compromising diagnostic accuracy.
- Performing joint fluid and histological analyses is crucial for ensuring accurate PJI diagnosis.
