The European Bone and Joint Infection Society definition of periprosthetic joint infection is meaningful in clinical practice: a multicentric validation study with comparison with previous definitions

Abstract

Background and purpose: A new periprosthetic joint infection (PJI) definition has recently been proposed by the European Bone and Joint Infection Society (EBJIS). The goals of this paper are to evaluate its diagnostic accuracy and compare it with previous definitions and to assess its accuracy in preoperative diagnosis.Patients and methods: We retrospectively evaluated a multicenter cohort of consecutive revision total hip and knee arthroplasties. Cases with minimum required diagnostic workup were classified according to EBJIS, 2018 International Consensus Meeting (ICM 2018), Infectious Diseases Society of America (IDSA), and modified 2013 Musculoskeletal Infection Society (MSIS) definitions. 2 years’ minimum follow-up was required to assess clinical outcome.Results: Of the 472 cases included, PJI was diagnosed in 195 (41%) cases using EBJIS; 188 (40%) cases using IDSA; 172 (36%) using ICM 2018; and 145 (31%) cases using MSIS. EBJIS defined fewer cases as intermediate (5% vs. 9%; p = 0.01) compared with ICM 2018. Specificity was determined by comparing risk of subsequent PJI after revision surgery. Infected cases were associated with higher risk of subsequent PJI in every definition. Cases classified as likely/confirmed infections using EBJIS among those classified as not infected in other definitions showed a significantly higher risk of subsequent PJI compared with concordant non-infected cases using MSIS (RR = 3, 95% CI 1–6), but not using ICM 2018 (RR = 2, CI 1–6) or IDSA (RR = 2, CI 1–5). EBJIS showed the highest agreement between pre-operative and definitive classification (k = 0.9, CI 0.8–0.9) and was better at ruling out PJI with an infection unlikely result (sensitivity 89% [84–93], negative predictive value 90% [85–93]).Conclusion: The newly proposed EBJIS definition emerged as the most sensitive of all major definitions. Cases classified as PJI according to the EBJIS criteria and not by other definitions seem to have increased risk of subsequent PJI compared with concordant non-infected cases. EBJIS classification is accurate in ruling out infection preoperatively.

Making the diagnosis in prosthetic joint infection: a European view

“…In a multicentre study of 697 revisions ( 56 ), the failure rate at 2 years after surgery was identical in cases with ≥2 positive cultures (17.9%), a single positive culture (17.0%) or culture-negative microbiology (17.2%), providing that the PJI was confirmed with the non-microbiological criteria in the EBJIS definition. This shows that EBJIS ‘confirmed’ culture-negative infections behave like EBJIS ‘confirmed’ culture-positive infections.…”

“…This question can also be addressed by using the clinical outcome as a ‘gold standard’ and correlating this with the diagnosis determined by each definition. In the multicentre study ( 56 ), it was shown that PJI diagnosis correlated closely with the outcome at 2 years, for all definitions (i.e. infected cases had a higher failure rate than non-infected cases).…”

“…It has been shown that different definitions perform differently in this ability, in any given cohort. The 2011 MSIS and its modified 2013 version have consistently been shown to identify less cases as infected ( 7 , 13 , 54 , 55 , 56 ). The ICM 2018 and the IDSA definitions are more sensitive, but the EBJIS definition identifies the largest proportion of cases as infected ( 7 , 55 , 56 , 57 ).…”

“…The 2011 MSIS and its modified 2013 version have consistently been shown to identify less cases as infected ( 7 , 13 , 54 , 55 , 56 ). The ICM 2018 and the IDSA definitions are more sensitive, but the EBJIS definition identifies the largest proportion of cases as infected ( 7 , 55 , 56 , 57 ). This trend may reflect our increasing awareness of so-called ‘low-grade infections’ or culture-negative infections, with the negative impact of unrecognised PJI on the outcome of revision arthroplasty.…”

Simple and inexpensive synovial fluid biomarkers for the diagnosis of prosthetic joint infection according to the new EBJIS definition

“…The EBJIS definition has been suggested to have increased sensitivity compared to previously proposed criteria, without negatively impacting specificity. It has also been showed to be better in preoperatively ruling out PJI when serological and synovial biomarkers yield negative results (Sigmund et al, 2022;Sousa et al, 2023).…”