Streck Laura Elisa, Sterneder Christian Manuel, Haralambiev Lyubomir, Brenneis Marco, Chiu Yu-Fen, Boettner Friedrich
Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
Department of Trauma and Reconstructive Surgery, BG Trauma Center Tuebingen, Eberhard Karls University Tuebingen, Schnarrenbergstr. 95, 72076, Tuebingen, Germany.
Arch Orthop Trauma Surg. 2025 Sep 9;145(1):441. doi: 10.1007/s00402-025-05994-7.
Differentiating periprosthetic joint infections (PJI) from aseptic failure is challenging in total joint arthroplasty. To date, there is no consensus about the most accurate criteria to diagnose PJI. The current study compares common diagnostic PJI criteria.
256 total hip and knee arthroplasties that underwent revision surgery between 2017 and 2022 were retrospectively classified as PJI or non PJI according to the following definitions: 2011 Musculoskeletal Infections Society (MSIS), 2013 Infectious Disease Society of America (IDSA), 2018 updated MSIS-criteria (MSIS-18), 2018 International Consensus Meeting on Periprosthetic Joint Infections (ICM), 2021 European Bone and Joint Infections Society (EBJIS), Pro-Implant Foundation, and the surgeons' assessment at the time of surgery. Accuracy, sensitivity, specificity, and predictive values were calculated with reference to (1) microbiological culture results, (2) MSIS-criteria, and (3) the surgeons' diagnosis. Results were compared between hip- and knee arthroplasties using Fisher's Exact- or Chi-square test, outcomes were compared between two criteria using Pearson correlation.
PJI was diagnosed in 47.7% of cases applying MSIS-criteria, 49.2% for IDSA-criteria, 52.3% for MSIS-18 criteria, 55.5% for ICM-criteria, 62.1% for EBJIS-criteria, 67.2% for Pro-Implant-criteria, and 55.1% according to the surgeons' judgment. Pro-Implant-criteria showed the lowest concordance with microbiological cultures and a rate of 35.5% culture negative infections. ICM- and MSIS-18-criteria showed best concordance with the surgeons' diagnosis.
The current study showed that the diagnosis of PJI is highly dependent on the applied diagnostic criteria. EBJIS- and Pro-Implant-criteria classified more cases as PJI compared to other diagnostic criteria. Care should be taken to avoid overdiagnosis and overtreatment, especially if low synovial white blood cell thresholds are applied as definite criteria to diagnose PJI.
在全关节置换术中，区分假体周围关节感染（PJI）与无菌性失败具有挑战性。迄今为止，关于诊断PJI的最准确标准尚无共识。本研究比较了常见的PJI诊断标准。
回顾性分析2017年至2022年间接受翻修手术的256例全髋关节和膝关节置换术病例，根据以下定义将其分为PJI或非PJI：2011年肌肉骨骼感染学会（MSIS）标准、2013年美国传染病学会（IDSA）标准、2018年更新的MSIS标准（MSIS - 18）、2018年假体周围关节感染国际共识会议（ICM）标准、2021年欧洲骨与关节感染学会（EBJIS）标准、Pro - Implant基金会标准以及手术时外科医生的评估。参照（1）微生物培养结果、（2）MSIS标准和（3）外科医生的诊断计算准确性、敏感性、特异性和预测值。使用Fisher精确检验或卡方检验比较髋关节和膝关节置换术之间的结果，使用Pearson相关性比较两个标准之间的结果。
根据MSIS标准，47.7%的病例被诊断为PJI；IDSA标准为49.2%；MSIS - 18标准为52.3%；ICM标准为55.5%；EBJIS标准为62.1%；Pro - Implant标准为67.2%；根据外科医生的判断为55.1%。Pro - Implant标准与微生物培养的一致性最低，培养阴性感染率为35.5%。ICM和MSIS - 18标准与外科医生的诊断一致性最佳。
本研究表明，PJI的诊断高度依赖于所应用的诊断标准。与其他诊断标准相比，EBJIS和Pro - Implant标准将更多病例分类为PJI。应注意避免过度诊断和过度治疗，特别是当应用低滑膜白细胞阈值作为诊断PJI的明确标准时。
