Hohmann Alexandra L, DeSimone Cristian A, Lowenstein Natalie A, Deirmengian Carl, Fillingham Yale A
Rothman Orthopaedic Institute, Philadelphia, PA, USA.
Clin Orthop Relat Res. 2025 Mar 12. doi: 10.1097/CORR.0000000000003457.
Numerous criterion-based definitions of periprosthetic joint infection (PJI) with differing criteria and point systems have been published, but the frequency of their use or application to study methods in publications on PJI has not been evaluated. Assessing the use of these definitions in studies is an important step to ensuring the validity and reproducibility of PJI research and to determining best practices for the application of these definitions in future research.
QUESTIONS/PURPOSES: As a scoping review, we identified and evaluated studies published since 2012 that defined PJI, and we asked: (1) Which of those definitions are cited most frequently in other peer-reviewed publications? (2) How often are the definition criteria and scoring systems reported in the methods beyond the name or citation or modified from the published definition? (3) How often did the PJI definition stated in a citing study's methods section fail to align with the definition provided in the cited source?
To identify published PJI definition citations, we queried PubMed for studies on PJI published between January 1, 2012, and August 1, 2023, identifying 75 unique citations in studies with human patients diagnosed with PJI. This study focused on PJI definitions detailing specific clinical and laboratory criteria for PJI, recognizing and including six formal definitions for PJI presented across 16 publications: the 2011 Musculoskeletal Infection Society (MSIS), 2013 MSIS/International Consensus Meeting (ICM), 2013 Infectious Disease Society of America (IDSA), 2018 ICM, and 2021 European Bone and Joint Infection Society (EBJIS) definitions, and an unendorsed 2018 Definition. Back citation of these 16 publications identified 457 studies (Journal of Arthroplasty n = 285, Clinical Orthopaedics and Related Research n = 69, Bone and Joint Journal n = 58, Journal of Bone and Joint Surgery n = 45) published between January 1, 2012, and December 31, 2022, that cited one of the identified PJI definition citations. Trends in PJI definition citation and reporting were assessed based on the following criteria: (1) the PJI definition claimed in the methods, (2) the cited reference to this claim, (3) the description of the definition in the manuscript, and (4) the definition modification.
Of 457 studies published between 2012 and 2022 that cited at least one PJI definition, the most cited was the 2011 MSIS definition (40% [183 studies]), followed by the 2013 MSIS/ICM definition (30% [139]), the unendorsed 2018 Definition (14% [65]), the 2018 ICM definition (3.7% [17]), the 2013 IDSA definition (3.5% [16]), and the 2021 EBJIS definition (one study); 7.9% (36) cited multiple definitions. Overall, 31% (141 of 457) of studies detailed the PJI definition beyond its name and citation. Authors modified definitions in 18% (83 of 457) of studies. Of the 98 studies using a definition with an inconclusive category, 18% (18 of 98) provided details on the inconclusive group. The PJI definition stated in the methods section did not align with the cited source in 19% (86 of 457) of studies. Of these, 85% (73 of 86) cited the unendorsed 2018 Definition while claiming use of an endorsed definition.
The 2011/2013 MSIS definitions of PJI remain commonly cited through 2022 despite the availability of newer definitions. Many studies on PJI definitions suffer from a lack of methodological transparency, hindering both reproducibility and the assessment of their validity. There also exists an alarming rate of citation errors and widespread use of unendorsed scoring systems despite claims of adherence to accepted standards, representing a systematic error in the existing scientific record.
In response to these findings, we recommend that academic societies establish a standard reporting framework and checklist for studies using formal PJI definitions, such as those that exist for systematic reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA]), randomized trials (Consolidated Standards of Reporting Trials [CONSORT]), and observational studies (Strengthening the Reporting of Observational Studies in Epidemiology [STROBE]). The MSIS and EBJIS, as discussed in an accompanying letter to the editor, are creating an endorsed standard reporting framework that aims to improve reporting transparency in the PJI research.
关于假体周围关节感染（PJI）的众多基于标准的定义已被发表，其标准和评分系统各不相同，但它们在PJI相关出版物中的使用频率或在研究方法中的应用尚未得到评估。评估这些定义在研究中的使用情况是确保PJI研究的有效性和可重复性以及确定在未来研究中应用这些定义的最佳实践的重要一步。
问题/目的：作为一项范围综述，我们识别并评估了自2012年以来发表的定义PJI的研究，我们提出以下问题：（1）在其他同行评审出版物中，哪些定义被引用得最频繁？（2）除了名称或引用之外，定义标准和评分系统在方法部分中被报告的频率有多高，或者与已发表的定义有何不同？（3）在引用研究的方法部分中陈述的PJI定义与被引用来源中提供的定义不一致的频率有多高？
为了识别已发表的PJI定义引用，我们在PubMed中查询了2012年1月1日至2023年8月1日期间发表的关于PJI的研究，在诊断为PJI的人类患者研究中识别出75条独特引用。本研究重点关注详细说明PJI特定临床和实验室标准的PJI定义，识别并纳入了16篇出版物中提出的PJI的六个正式定义：2011年肌肉骨骼感染学会（MSIS）、2013年MSIS/国际共识会议（ICM）、2013年美国传染病学会（IDSA）、2018年ICM和2021年欧洲骨与关节感染学会（EBJIS）的定义，以及一个未获认可的2018年定义。对这16篇出版物的反向引用识别出了2012年1月1日至2022年12月31日期间发表的457项研究（《关节置换术杂志》n = 285，《临床骨科与相关研究》n = 69，《骨与关节杂志》n = 58，《骨与关节外科杂志》n = 45），这些研究引用了已识别的PJI定义引用之一。基于以下标准评估PJI定义引用和报告的趋势：（1）方法中声称的PJI定义，（2）对此声称的引用参考文献，（3）手稿中对定义的描述，以及（4）定义修改。
在2012年至2022年发表的至少引用一个PJI定义的457项研究中，引用最多的是2011年MSIS定义（40%[183项研究]），其次是2013年MSIS/ICM定义（30%[139项]），未获认可的2018年定义（14%[65项]），2018年ICM定义（3.7%[17项]），2013年IDSA定义（3.5%[16项]），以及2021年EBJIS定义（一项研究）；7.9%（36项）引用了多个定义。总体而言，31%（457项中的141项）的研究详细说明了PJI定义，而不仅仅是其名称和引用。18%（457项中的83项）的研究中作者修改了定义。在使用具有不确定类别的定义的98项研究中，18%（98项中的18项）提供了关于不确定组的详细信息。457项研究中有19%（86项）的方法部分中陈述的PJI定义与被引用来源不一致。其中，85%（86项中的73项）在声称使用认可定义的同时引用了未获认可的2018年定义。
尽管有更新的定义，但2011/2013年MSIS的PJI定义在2022年之前仍被频繁引用。许多关于PJI定义的研究缺乏方法学透明度，这既阻碍了可重复性，也妨碍了对其有效性的评估。尽管声称遵循公认标准，但引用错误率惊人，未获认可的评分系统广泛使用，这在现有科学记录中代表了一种系统误差。
针对这些发现，我们建议学术团体为使用正式PJI定义的研究建立一个标准报告框架和清单，例如那些用于系统评价（系统评价和荟萃分析的首选报告项目[PRISMA]）、随机试验（试验报告的统一标准[CONSORT]）和观察性研究（加强流行病学观察性研究报告[STROBE]）的框架。如随附给编辑的信中所讨论的，MSIS和EBJIS正在创建一个认可的标准报告框架，旨在提高PJI研究中的报告透明度。
