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Are All Periprosthetic Joint Infections the Same? Evaluating Major vs Minor Criteria
Mitchell R Klement1, Ahmed Siddiqi2, Justin M Rock1
1Department of Orthopedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Background:
The diagnosis of periprosthetic joint infection (PJI) can be made when 1 major criterion or 3 of 5 minor criteria are present. However, the outcomes of patients with a major vs minor criteria for diagnosis have not been studied. The objective of this study was to evaluate if a difference in outcome of surgical intervention existed between patients with PJI who were diagnosed with a major criterion or a combination of minor criteria.
Methods:
A retrospective chart review identified 277 primary total hip or knee arthroplasty patients who had developed PJI based on the International Consensus Meeting definition. Patients were further stratified into "major" vs "minor" groups. Patient demographics, PJI workup, surgical treatment, microbiological growth, and clinical outcomes were recorded. Treatment success was defined by using the Delphi criteria. Standard statistical analysis was performed.
Results:
Overall, 34 patients met minor-only criteria (12.2%), whereas 243 met major criteria. Of the minor-only patients, 16 (47%) were culture negative. When controlling for confounding variables, there was no statistically significant difference with regard to treatment success (minor 94.1% vs major 82.3%, P = .085) between groups at final follow-up (mean 110 months, range 2.3-567 months). Only higher Charlson comorbidity index (P = .001) and an initial 2-stage surgical procedure (P = .003) were associated with decreased treatment success.
Conclusion:
PJI patients were similar between both criteria groups, and there was no difference in treatment success as defined by the Delphi criteria between minor-only PJI and major criteria PJI patients.
Insights
Periprosthetic joint infection (PJI) diagnosis using minor criteria alone shows similar treatment success to major criteria. This study found no significant difference in outcomes for patients with periprosthetic joint infection, regardless of diagnostic criteria used.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Medical Diagnostics
Background:
- Periprosthetic joint infection (PJI) diagnosis relies on major or minor criteria.
- Outcomes based on diagnostic criteria (major vs. minor) for PJI have not been extensively studied.
- Evaluating treatment success differences between PJI patients diagnosed by major versus minor criteria is crucial for clinical management.
Purpose of the Study:
- To compare the surgical intervention outcomes of patients diagnosed with periprosthetic joint infection (PJI) using a major criterion versus a combination of minor criteria.
- To determine if diagnostic criteria for PJI influence the success rate of surgical treatments.
- To analyze treatment success rates based on the Delphi criteria for PJI patients stratified by diagnostic criteria.
Main Methods:
- Retrospective chart review of 277 primary total hip or knee arthroplasty patients with PJI.
- Stratification of patients into "major" diagnostic criteria group and "minor" diagnostic criteria group.
- Recording of demographics, PJI workup, surgical treatment, microbiological data, and clinical outcomes, with treatment success defined by Delphi criteria.
Main Results:
- 34 patients (12.2%) met minor-only criteria for PJI; 16 (47%) of these were culture-negative.
- No statistically significant difference in treatment success was observed between minor-only PJI (94.1%) and major criteria PJI (82.3%) groups (P = .085) after controlling for confounding variables.
- Higher Charlson comorbidity index and initial 2-stage surgical procedures were associated with decreased treatment success in PJI patients.
Conclusions:
- Periprosthetic joint infection (PJI) patients diagnosed by minor-only criteria demonstrated similar treatment success rates to those diagnosed by major criteria.
- The diagnostic criteria used for periprosthetic joint infection (PJI) did not significantly impact treatment success as defined by the Delphi criteria.
- Clinical outcomes for PJI are not significantly different based on whether a major criterion or a combination of minor criteria is used for diagnosis.
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