H Mühlhofer1, N Renz2, A Zahar3, M Lüdemann4, M Rudert4, R Hube5, L Frommelt6, R Ascherl7, C Perka2, R von Eisenhart-Rothe8. 1. Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland. heinrich.muehlhofer@tum.de. 2. Centrum für Muskuloskeletale Chirurgie, Campus Charité Mitte, Charite, Luisenstraße 64, 10117, Berlin, Deutschland. 3. Helios Klinikum Emil von Behring, Walterhöferstr. 11, 14165, Berlin, Deutschland. 4. Orthopädische Klinik, König-Ludwig-Haus, Brettreichstraße 11, 97074, Würzburg, Deutschland. 5. Orthopädische Chirurgie München, OCM Klinik München, Steinerstr. 6, 81369, München, Deutschland. 6. Helios ENDO-Klinik Hamburg, Holstenstraße 2, 22767, Hamburg, Deutschland. 7. , Kirchham, Deutschland. 8. Klinik und Poliklinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
Abstract
BACKGROUND: Prosthetic joint infections (PPI) will challenge orthopaedic surgeons and the health care system in the coming years. Evidence-based and reliable preoperative diagnostics are necessary for success in the field of revision arthroplasty. Especially the preoperative detection of PPI is important with respect to the treatment strategy. AIM: The aim of this study was to develop a detailed and structured standard operating procedure (SOP) to detect PPI preoperatively. METHODS: A systematic literature research was performed and relevant articles identified. After extracting the data, statistical calculations of sensitivity, specificity, positive/negative predictive value and positive/negative likelihood ratio were performed. The results were discussed and evaluated in four meetings analogously to standard Delphi rounds by the workgroup of implant-associated infections of the German AE (Arbeitsgemeinschaft Endoprothetik). An algorithm for the diagnostic approach according to ISO 5807 was made. RESULTS: The standardized algorithm combines a sequence of evidence-based procedures with detailed and structured main and additional criteria to every critical step in the diagnostic approach. CONCLUSION: The detection of PPI is of tremendous importance prior to revision arthroplasty and determines its success or failure. The diagnosis "prosthetic joint infection" requires a substantial change with respect to treatment concepts. The algorithm summarizes current literature and specialized expert opinions in a modern standardized format for a transparent diagnostic approach.
BACKGROUND: Prosthetic joint infections (PPI) will challenge orthopaedic surgeons and the health care system in the coming years. Evidence-based and reliable preoperative diagnostics are necessary for success in the field of revision arthroplasty. Especially the preoperative detection of PPI is important with respect to the treatment strategy. AIM: The aim of this study was to develop a detailed and structured standard operating procedure (SOP) to detect PPI preoperatively. METHODS: A systematic literature research was performed and relevant articles identified. After extracting the data, statistical calculations of sensitivity, specificity, positive/negative predictive value and positive/negative likelihood ratio were performed. The results were discussed and evaluated in four meetings analogously to standard Delphi rounds by the workgroup of implant-associated infections of the German AE (Arbeitsgemeinschaft Endoprothetik). An algorithm for the diagnostic approach according to ISO 5807 was made. RESULTS: The standardized algorithm combines a sequence of evidence-based procedures with detailed and structured main and additional criteria to every critical step in the diagnostic approach. CONCLUSION: The detection of PPI is of tremendous importance prior to revision arthroplasty and determines its success or failure. The diagnosis "prosthetic joint infection" requires a substantial change with respect to treatment concepts. The algorithm summarizes current literature and specialized expert opinions in a modern standardized format for a transparent diagnostic approach.
Authors: Maximilian F Kasparek; Michael Kasparek; Friedrich Boettner; Martin Faschingbauer; Julia Hahne; Martin Dominkus Journal: J Arthroplasty Date: 2016-05-27 Impact factor: 4.757
Authors: Benjamin Zmistowski; Joseph A Karam; Joel B Durinka; David S Casper; Javad Parvizi Journal: J Bone Joint Surg Am Date: 2013-12-18 Impact factor: 5.284
Authors: E F Berbari; A D Hanssen; M C Duffy; J M Steckelberg; D M Ilstrup; W S Harmsen; D R Osmon Journal: Clin Infect Dis Date: 1998-11 Impact factor: 9.079
Authors: Farhan Ali; J Mark Wilkinson; J Robert Cooper; Robert M Kerry; Andrew J Hamer; Paul Norman; Ian Stockley Journal: J Arthroplasty Date: 2006-02 Impact factor: 4.757
Authors: Florian Pohlig; Heinrich M L Mühlhofer; Ulrich Lenze; Florian W Lenze; Christian Suren; Norbert Harrasser; Rüdiger von Eisenhart-Rothe; Johannes Schauwecker Journal: Eur J Med Res Date: 2017-03-04 Impact factor: 2.175
Authors: Christian Suren; Igor Lazic; Maximilian Stephan; Florian Walter Lenze; Florian Pohlig; Rüdiger von Eisenhart-Rothe Journal: J Orthop Date: 2021-01-28
Authors: Sebastian Philipp Boelch; Kilian Rüeckl; Laura Elisa Streck; Viktoria Szewczykowski; Manuel Weißenberger; Axel Jakuscheit; Maximilian Rudert Journal: Biomed Res Int Date: 2021-11-19 Impact factor: 3.411
Authors: Thomas Ackmann; Burkhard Möllenbeck; Georg Gosheger; Jan Schwarze; Tom Schmidt-Braekling; Kristian Nikolaus Schneider; Adrien Frommer; Ralf Dieckmann; Christoph Theil Journal: J Clin Med Date: 2020-09-10 Impact factor: 4.241