Department of Orthopaedic Surgery, Helios ENDO-Klinik, Hamburg, Germany.
Department of Orthopaedic Surgery, Helios ENDO-Klinik, Hamburg, Germany; Department of Surgery, Ruhr-University Hospital, Bochum, Germany.
J Arthroplasty. 2020 Aug;35(8):2200-2203. doi: 10.1016/j.arth.2020.03.014. Epub 2020 Mar 13.
Recently, a revised definition of the minor criteria scoring system for diagnosing periprosthetic joint infection (PJI) was developed by the second International Consensus Meeting on musculoskeletal infection. The new system combines preoperative and intraoperative findings, reportedly achieving high sensitivity and specificity. We aimed to validate the modified scoring system at a high-volume center.
We retrospectively reviewed patients who underwent a revision total hip or knee arthroplasty at our institution from May 2015 to August 2018. Serum C-reactive protein, synovial white blood cell count and polymorphonuclear percentage, leukocyte esterase test, alpha-defensin, microbiological and histologic results, and documented existence of sinus tract and intraoperative purulence were available for all patients. Cases with at least 1 major criterion were considered as infected. Using the new minor criteria, a score of ≥6 reflects PJI, while a score <3 can be considered as noninfected. Sensitivity, specificity, mean accuracy (ACC), positive predictive value (PPV), and negative predictive value (NPV) were analyzed.
A total of 345 cases were included. A cutoff score of ≥6 points had the following diagnostic performance: area under the curve (AUC) = 0.90; ACC = 0.88; sensitivity = 0.96; specificity = 0.84; PPV = 0.70; NPV = 0.98. Diagnostic performance was better for the hip (AUC = 0.92; ACC = 0.90; sensitivity = 0.96; specificity = 0.86; PPV = 0.81; NPV = 0.98) than the knee (AUC = 0.89; ACC = 0.85; sensitivity = 0.95; specificity = 0.83; PPV = 0.59; NPV = 0.98).
The modified scoring system proposed by the 2018 International Consensus Meeting in diagnosing PJI showed high sensitivity and a good performance, especially as rule-out diagnostic criteria. The cutoff level seems to be different between the hip and knee. Further validation studies considering the acknowledged limitations are recommended.
最近，第二届国际肌肉骨骼感染共识会议制定了修订后的假体周围关节感染（PJI）次要标准评分系统的定义。新系统结合了术前和术中的发现，据称具有较高的敏感性和特异性。我们旨在高容量中心验证改良评分系统。
我们回顾性地审查了 2015 年 5 月至 2018 年 8 月期间在我院接受翻修全髋关节或膝关节置换术的患者。所有患者均有血清 C 反应蛋白、滑膜白细胞计数和多形核细胞百分比、白细胞酯酶试验、α-防御素、微生物学和组织学结果以及窦道和术中脓液的存在记录。至少有 1 项主要标准的病例被认为是感染。使用新的次要标准，评分≥6 反映 PJI，而评分<3 可视为非感染。分析了敏感性、特异性、平均准确度（ACC）、阳性预测值（PPV）和阴性预测值（NPV）。
共纳入 345 例。截点评分≥6 分具有以下诊断性能：曲线下面积（AUC）=0.90；ACC=0.88；敏感性=0.96；特异性=0.84；PPV=0.70；NPV=0.98。髋关节（AUC=0.92；ACC=0.90；敏感性=0.96；特异性=0.86；PPV=0.81；NPV=0.98）的诊断性能优于膝关节（AUC=0.89；ACC=0.85；敏感性=0.95；特异性=0.83；PPV=0.59；NPV=0.98）。
2018 年国际共识会议提出的改良评分系统在诊断 PJI 方面具有较高的敏感性和良好的性能，尤其是作为排除性诊断标准。髋关节和膝关节之间的截止水平似乎有所不同。建议进行进一步的验证研究，以考虑到公认的局限性。
