Department of Ortopaedic Surgery, ENDO-Klinik Hamburg, Hamburg, Germany; Department of Orthopaedics and Traumatology, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Health Sciences University, Sanliurfa, Turkey.
Department of Ortopaedic Surgery, ENDO-Klinik Hamburg, Hamburg, Germany.
J Arthroplasty. 2021 Nov;36(11):3728-3733. doi: 10.1016/j.arth.2021.06.030. Epub 2021 Jun 30.
The accurate preoperative diagnosis of periprosthetic joint infection (PJI) is critical. The aim of this study was to evaluate the diagnostic accuracy and performance of the 2018 International Consensus Meeting (ICM) preoperative minor criteria for the diagnosis of chronic PJI in total hip and knee arthroplasty.
We retrospectively reviewed 260 patients that underwent a revision knee or hip arthroplasty at our institution between 2015 and 2017. All major and minor 2018 ICM criteria (except erythrocyte sedimentation rate, D-dimer) were available for all patients included. Cases with at least 1 major criterion were considered as infected. Receiver operative characteristic curve analysis was performed for preoperative minor criteria.
The diagnostic performance of the preoperative minor criteria ranked as per the area under the curve was PMN% (0.926), alpha defensin (0.922), white blood cell count (0.916), leukocyte esterase (0.861), and serum C-reactive protein (0.860). Increasing the PMN % cutoff from 70% to 77.8% improves the diagnostic accuracy (86.5% vs 90.8%). The highest diagnostic performance was achieved by combining all 5 preoperative parameters, and at current ICM thresholds, the diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive were 93.5%, 95.4%, 92.1%, 89.7%, and 96.5%, respectively.
The diagnostic performance of preoperative minor criteria was outstanding (PMN%, alpha defensin, white blood cell count) or excellent (leukocyte esterase, serum C-reactive protein). PMN% showed the best diagnostic utility (area under the curve) and should have an increased weight-adjusted score in the ICM scoring system.
准确的术前诊断假体周围关节感染（PJI）至关重要。本研究旨在评估 2018 年国际共识会议（ICM）术前小标准对全髋关节和膝关节置换术后慢性 PJI 的诊断准确性和性能。
我们回顾性分析了 2015 年至 2017 年期间在我院接受翻修膝关节或髋关节置换术的 260 例患者。所有患者均符合 2018 年 ICM 的主要和次要标准（除红细胞沉降率、D-二聚体外）。至少有 1 个主要标准的病例被认为是感染的。对术前小标准进行受试者工作特征曲线分析。
术前小标准的诊断性能按曲线下面积排列为PMN%（0.926）、α防御素（0.922）、白细胞计数（0.916）、白细胞酯酶（0.861）和血清 C 反应蛋白（0.860）。将PMN%的截止值从 70%提高到 77.8%可提高诊断准确性（86.5%比 90.8%）。5 项术前参数的联合诊断性能最高，在当前 ICM 阈值下，诊断准确性、敏感性、特异性、阳性预测值和阴性预测值分别为 93.5%、95.4%、92.1%、89.7%和 96.5%。
术前小标准的诊断性能优异（PMN%、α防御素、白细胞计数）或卓越（白细胞酯酶、血清 C 反应蛋白）。PMN%显示出最佳的诊断效果（曲线下面积），并且应该在 ICM 评分系统中增加加权评分。
