Making the diagnosis in prosthetic joint infection: a European view

McNally, Martin; Sigmund, Irene Katharina; Hotchen, Andrew J.; Sousa, Ricardo

doi:10.1530/eor-23-0044

Cited by 14 publications

(8 citation statements)

References 73 publications

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“…The diagnostic algorithm used in this retrospective study has been elaborated according to the SA/PJI diagnostic criteria as presented by the 2018 International Consensus Meeting for Periprosthetic Joint Infections [ 25 ] and the European Bone and Joint Infection Society [ 17 ]. The algorithm has been completed by the implementation of modern, synovial fluid molecular testing technologies that have been recently recommended by multiple authors [ 5 , 12 , 22 , 23 , 26 ].…”

Section: Methodsmentioning

confidence: 99%

“…In the post‐SARS‐CoV‐2 era, which has seen the popularization of molecular testing, recommendations from North American [ 25 ] and European scientific societies [ 17 ] are still based on the use of culture‐based techniques to identify the microorganism causative of a joint infection. This approach has been recently challenged by multiple authors, who have successfully started to utilize molecular testing technologies to identify aseptic arthritis and PJI‐causing microorganisms [ 5 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

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Multiplex PCR in septic arthritis and periprosthetic joint infections microorganism identification: Results from the application of a new molecular testing diagnostic algorithm

Ghirardelli,

Scaggiante,

Troi

et al. 2024

J. exp. orthop.

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PurposePathogen identification is key in the treatment of septic arthritis (SA) and periprosthetic joint infections (PJI). This study evaluates the outcome of the application of a new, score‐based SA and PJI diagnostic algorithm, which includes the execution of molecular testing on synovial fluid.MethodsA score‐based diagnostic algorithm, which includes serologic and synovial fluid markers determination using multiplex PCR (mPCR) and Next Generation Sequencing (NGS) molecular testing, has been applied to a consecutive series of patients with clinically suspected SA or PJI. Patients with a score ≥6 underwent synovial fluid molecular testing, together with traditional culture, to identify the pathogen and its genetically determined antibiotic resistance.ResultsOne hundred and seventeen joints in 117 patients (62.5% women; average age 73 years) met the criteria for possible SA/PJI. The affected joint was the knee in 87.5% (joint replacement 66.5%; native joint 21%) and the hip in 12.5% (all replaced joints). 43/117 patients (36.7%) were ultimately diagnosed with SA/PJI. Among the various testing technologies applied, mPCR was the main determinant for pathogen identification in 63%, standard culture in 26%, and mNGS in 11%. Staphylococcus aureus and Enterococcus faecalis were the top two microorganisms identified by mPCR, while Staphylococcus epidermidis was the prevalent organism identified by NGS. mPCR detected the presence/absence of the genetically determined antibiotic resistance of all identified microorganisms. The average timeframe for pathogen identification was 3.13 h for mPCR, 4.5 days for culture, and 3.2 days for NGS.ConclusionsMolecular diagnostic technologies represent an innovative screening for fast microorganism identification when a joint infection is clinically suspected.Level of EvidenceLevel IV, case series.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multiplex PCR in septic arthritis and periprosthetic joint infections microorganism identification: Results from the application of a new molecular testing diagnostic algorithm

Ghirardelli,

Scaggiante,

Troi

et al. 2024

J. exp. orthop.

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“…Unfortunately, there is a high degree of overlap in these signs between periprosthetic infections, aseptic loosening and loosening induced by abraded particles. Neither CT, MRI nor ultrasound are included in the current diagnostic catalogs of ICM, MSIS and EBJIS [9,12,15].…”

Section: Imaging Proceduresmentioning

confidence: 99%

“…The evolution of the definition of periprosthetic infection (Figure 1) took several years, the first definition was established by the Musculoskeletal Infection Society (MSIS) in 2011. Two main criteria and six secondary criteria were specified, whereby a periprosthetic infection was assumed if at least one of the main criteria or four of the six secondary criteria were met [12]. One year later, the Infectious Diseases Society of America (IDSA) published a simplified definition based on the presence of at least one of five criteria [13].…”

Section: Introductionmentioning

confidence: 99%

Diagnostics in Late Periprosthetic Infections—Challenges and Solutions

Sax,

Hoyka,

Blersch

et al. 2024

Antibiotics

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The rising number of arthroplasties is combined with a rising number of periprosthetic joint infections, which leads to life-concerning consequences for the patients, including extended antibiotic treatment, further surgery and increased mortality. The heterogeneity of the symptoms and inflammatory response of the patients due to, e.g., age and comorbidities and the absence of a single diagnostic test with 100% accuracy make it very challenging to choose the right parameters to confirm or deny a periprosthetic joint infection and to establish a standardized definition. In recent years, additional diagnostic possibilities have emerged primarily through the increasing availability of new diagnostic methods, such as genetic techniques. The aim of the review is to provide an overview of the current state of knowledge about the various tests, including the latest developments. The combination of different tests increases the accuracy of the diagnosis. Each physician or clinical department must select the tests from the available methods that can be best implemented for them in organizational and technical terms. Serological parameters and the cultivation of the samples from aspiration or biopsy should be combined with additional synovial tests to create an accurate figure for the failure of the prosthesis, while imaging procedures are used to obtain additional information for the planned therapeutic procedure.

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“…Periprosthetic joint infection is among the main complications in orthopaedic surgery, representing the second most frequent indication for replacement surgery in the knee and the fourth in the hip, with an overall incidence of about 2% [ 1 – 3 ]. The least aggressive among currently available surgical therapies is debridement with implant retention (DAIR).…”

Section: Introductionmentioning

confidence: 99%

Biofilm on total joint replacement materials can be reduced through electromagnetic induction heating using a portable device

Enrique,

Medel-Plaza,

Correa

et al. 2024

J Orthop Surg Res

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Background Periprosthetic joint infection is a serious complication following joint replacement. The development of bacterial biofilms bestows antibiotic resistance and restricts treatment via implant retention surgery. Electromagnetic induction heating is a novel technique for antibacterial treatment of metallic surfaces that has demonstrated in-vitro efficacy. Previous studies have always employed stationary, non-portable devices. This study aims to assess the in-vitro efficacy of induction-heating disinfection of metallic surfaces using a new Portable Disinfection System based on Induction Heating. Methods Mature biofilms of three bacterial species: S. epidermidis ATCC 35,984, S. aureus ATCC 25,923, E. coli ATCC 25,922, were grown on 18 × 2 mm cylindrical coupons of Titanium-Aluminium-Vanadium (Ti6Al4V) or Cobalt-chromium-molybdenum (CoCrMo) alloys. Study intervention was induction-heating of the coupon surface up to 70ºC for 210s, performed using the Portable Disinfection System (PDSIH). Temperature was monitored using thermographic imaging. For each bacterial strain and each metallic alloy, experiments and controls were conducted in triplicate. Bacterial load was quantified through scraping and drop plate techniques. Data were evaluated using non-parametric Mann-Whitney U test for 2 group comparison. Statistical significance was fixed at p ≤ 0.05. Results All bacterial strains showed a statistically significant reduction of CFU per surface area in both materials. Bacterial load reduction amounted to 0.507 and 0.602 Log10 CFU/mL for S. aureus on Ti6Al4V and CoCrMo respectively, 5.937 and 3.500 Log10 CFU/mL for E. coli, and 1.222 and 0.372 Log10 CFU/mL for S. epidermidis. Conclusions Electromagnetic induction heating using PDSIH is efficacious to reduce mature biofilms of S aureus, E coli and S epidermidis growing on metallic surfaces of Ti6Al4V and CoCrMo alloys.

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Making the diagnosis in prosthetic joint infection: a European view

Cited by 14 publications

References 73 publications

Multiplex PCR in septic arthritis and periprosthetic joint infections microorganism identification: Results from the application of a new molecular testing diagnostic algorithm

Multiplex PCR in septic arthritis and periprosthetic joint infections microorganism identification: Results from the application of a new molecular testing diagnostic algorithm

Diagnostics in Late Periprosthetic Infections—Challenges and Solutions

Biofilm on total joint replacement materials can be reduced through electromagnetic induction heating using a portable device

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