Periprosthetic infection: diagnostic and treatment. Part 1 (literature review)
Keywords:arthroplasty, periprosthetic infection, diagnostics, etiology, surgical treatment
AbstractHip and knee joints replacement became widespread in the world and Ukraine due to their high efficiency and improvement of life quality. However, similar to any other surgical intervention, it is not without complications. Periprosthetic infection is among the most difficult complications because it could easily negate all the efforts of the surgeon and patient to achieve a positive result. Very little attention was paid to this very serious disease in Ukrainian medical journals. The authors have presented information from scientific literature concerning the possibilities of various modern diagnostic techniques used to determine periprosthetic infections. The most widely used classifications are described. The modern diagnostic criteria that based on International Consensus Conference on periprosthetic infection (2013) and used as a basis for diagnosis establishing are provided. Such diagnostic tests as serologic (C-reactive protein, erythrocyte sedimentation rate, interleukins, procalcitonin, tumor necrosis factor, and combinations there of) microbiological, synovial, histological are listed from the standpoint of their sensitivity and specificity in the preoperative and intraoperative phases, their thresholds are presented. The authors systematized information to determine the main pointsof dignostics and treatment of this complication. The necessity in early and most complete diagnostics of infection with accurate determining of the pathogen is emphasized since the choice of optimal treatment (surgical and antibacterial) is based on these results. Only with the right method of treatment chosen, based on accurate and timely diagnostics, doctor and patient can expect success in the fight against infection.
Parvizi J, Ghanem E, Azzam K, Davis E, Jaberi F, Hozack W Periprosthetic infection: are current treatment strategies adequate? Acta Orthop Belg. 2008;74(6)793–800.
Della Valle CJ, Zuckerman JD, Di Cesare PE. Periprosthetic sepsis. Clin Orthop Relat Res. 2004;420:26–31.
Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 2012;27(8);61–5. doi: 10.1016/j.arth.2012.02.022.
Coventry MB. Treatment of infections occurring in total hip surgery. Orthop. Clin North Am. 1975;6:991–1003.
Tsukayama DT, Estrada R, Gustilo RB. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am. 1996;78:512–23.
Zimmerli W, Ochsner PE. Management of infection associated with
prosthetic joints. Infection. 2003;31:99–108.
McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M. Periprosthetic total hip infection: outcomes using a staging system. Clin Orthop Relat Res. 2002;403:8–15.
Parvizi J, Ghanem E, Sharkey P, Aggarwal A, Burnett RS, Barrack RL. Diagnosis of infected total knee: findings of a multicenter database. Clin Orthop Rela. Res. 2008;466(11):2628–33. doi: 10.1007/s11999-008-0471-5.
Bauer TW, Parvizi J, Kobayashi N, Krebs V. Diagnosis of periprosthetic infection. J Bone Joint Surg. Am. 2006;88(4):869–82.
Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, Garvin KL, Mont MA, Wongworawat MD, Zalavras CG. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res. 2011;469(11):2992–94. doi: 10.1007/s11999-011-2102-9.
Parvizi J, Gehrke T, Chen AF. Proceedings of the International Consensus on Periprosthetic Joint Infection. Bone Joint J. 2013;95-B(11):1450–2. doi: 10.1302/0301-620X.95B11.33135.
Berbari E, Mabry T, Tsaras G, Spangehl M, Erwin PJ, Murad MH, Steckelberg J, Osmon D. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am. 2010;92(11):2102–09. doi: 10.2106/JBJS.I.01199.
Spangehl MJ, Masri BA, O’Connell JX, Duncan CP. Prospective analysis of preoperative and intraoperative investigationsfor the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Joint Surg. Am. 1999;81-A(4):672–83.
The diagnosis of periprosthetic joint infections of the hip and knee guideline and evidence report. Adopted by the American Academy of Orthopaedic Surgeons. Board of Directors June 18, 2010. Access mode: http://www.aaos.org/research/guide-lines/PJIguideline.pdf.
Greidanus NV, Masri BA, Garbuz DS, Wilson SD, McAlinden MG, Xu M, Duncan CP. Use of erythrocyte sedimentation rate and C-reactive protein level to diagnose infection before revision total knee arthroplasty. A prospective evaluation. J Bone Joint Surg Am. 2007;89(7):1409–16.
Shah K, Mohammed A, Patil S, McFadyen A, Meek RM. Circulating cytokines after hip and knee arthroplasty. Clin Orthop Relat Res. 2009;46(4):946–51. doi: 10.1007/s11999-008-0562-3.
Austin MS, Ghanem E, Joshi A, Lindsay A, Parvizi J. A simple, cost-effective screening protocol to rule out periprosthetic infection. J Arthroplasty. 2008;23(1):65–8. doi: 10.1016/j.arth.2007.09.005.
Di Cesare PE, Chang E, Preston CF, Liu CJ. Serum interleukin-6 as a marker of periprosthetic infection following total hip and knee arthroplasty. J Bone Joint Surg. Am. 2005;87(9):1921–1927.
Bottner F, Wegner A, Winkelmann W, Becker K, Erren M, Götze C. Interleukin-6, procalcitonin and TNF-alpha: markers of periprosthetic infection following total joint replacement. J Bone Joint Surg Br. 2007;89(1):94–9.
Bouaicha S, Blatter S, Moor BK, Spanaus K, Dora C, Werner CM. Early serum procalcitonin level after primary total hip replacement. Mediators Inflam. 2013;2013(ID 927636). doi: 10.1155/2013/927636.
Randau TM, Friedrich MJ, Wimmer MD, Reichert B, Kuberra D, Stoffel-Wagner B, Limmer A, Wirtz DC, Gravius S. Interleukin-6 in serum and in synovial fluid enhances the differentiation between periprosthetic joint infection and aseptic loosening. PLoS One. 2014;(2):ID e89045. doi:10.1371/journal.pone.0089045.www.plosone.org.
Fink B, Makowiak C, Fuerst M, Berger I, Schäfer P, Frommelt L. The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late periprosthetic infection of total knee replacements. J Bone Joint Surg Br. 2008;90(7):874–8. doi: 10.1302/0301-620X.90B7.20417.
Achermann Y, Vogt M, Leunig M, Wüst J, Trampuz A. Sonication of removed hip and knee prostheses for improved diagnosis of infection. N Engl J Med. 2007;357(7):654–63.
Nickinson RS, Board TN, Gambhir AK, Porter ML, Kay PR. The microbiology of the infected knee arthroplasty. Int Orthop. 2010;34(4):505–10. doi: 10.1007/s00264-009-0797-y.
Stefánsdóttir A, Johansson D, Knutson K, Lidgren L, Robertsson O. Microbiology of the infected knee arthroplasty: report from the Swedish Knee Arthroplasty Register on 426 surgically revised cases. Scand J Infect. Dis. 2009;41(11–12):831–40. doi: 10.3109/00365540903186207.
Sharma D, Douglas J, Coulter C, Weinrauch P, Crawford R. Microbiology of infected arthroplasty: implications for empiric peri-operative antibiotics. Orthop Surg. (Hong Kong). 2008;16(3):339–42.
Vyrva OE, Burlaka V, Malyk RV, Ozerov KI, et al. Infectious complications of the primary total hip and knee. Orthopаedics Traumatology and Prosthetics. 2011;(3):60–7. doi: 10.15674/0030-59872011360-67.
Bozhkova SA, Bogdanov TY, Krasnov MV, et al. Experimental and clinical study of phenotypic features of strains of S. epidermidis and their role in the occurrence and development of implant-related infection after orthopedic surgery. Traumatology and orthopаedics of Russia. 2014;2(72):68–77.
Bidnenko SI, Gritsay OB, Lütke OB, et al. Modern aspects of etiologic diagnosis periprosthetic infection after total hip and knee. Bulletin of orthopаedics, traumatology and prosthetics. 2008;(1):22–7.
Bidnenko SI, Lutko OB, Ozeryanskaya NM. Periprosthetic infection рathogens and their sensitivity to antibiotics. Orthopedics Traumatology and Prosthetics. 2008;(3):60–5.
Dinneen A, Guyot A, Clements J, Bradley N. Synovial fluid white cell and differential count in the diag-nosis or exclusion of prosthetic joint infection. Bone Joint J. 2013;95-B(4):554–7. doi: 10.1302/0301-620X.95B4.30388.
Ghanem E, Parvizi J, Burnett RS, Sharkey PF, Keshavarzi N, Aggarwal A, Barrack RL. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg Am. 2008;90(8):1637–43. doi: 10.2106/JBJS.G.00470.
Bedair H1, Ting N, Jacovides C, Saxena A, Moric M, Parvizi J, Della Valle CJ. Diagnosis of early postoperative TKA infection using synovial fluid analysis. Clin Orthop Relat Res. 2011;469(1):34–40. doi: 10.1007/s11999-010-1433-2.
Omar M, Ettinger M, Reichling M, Petri M, Guenther D, Gehrke T, Krettek C, Mommsen P. Synovial C-reactive protein as a marker for chronic periprosthetic infection in total hip arthroplasty. Bone Joint J. 2015;97-B(2):173–6. doi: 10.1302/0301-620X.97B2.34550.
Parvizi J1, Jacovides C, Adeli B, Jung KA, Hozack WJ. Mark B. Coventry Award: synovial C-reactive protein: a prospective evaluation of a molecular marker for periprosthetic knee joint infection. Clin Orthop Relat Res. 2012;470(1):54–60. doi: 10.1007/s11999-011-1991-y.
Parvizi J, McKenzie JC, Cashman JP. Diagnosis of periprosthetic joint infection using synovial C-reactive protein. J Arthroplasty. 2012;27(8):12–6. doi: 10.1016/j.arth.2012.03.018.
Tetreault MW, Wetters NG, Moric M, Gross CE, Della Valle CJ. Is synovial C-reactive protein a useful marker for periprosthetic joint infection? Clin Orthop Relat Res. 2014;472(12):3997–4003. doi: 10.1007/s11999-014-3828-y.
Deirmengian C1, Hallab N, Tarabishy A, Della Valle C, Jacobs JJ, Lonner J, Booth RE Jr. Synovial fluid biomarkers for periprosthetic infection. Clin Orthop Relat. Res. 2010;468(8):2017–3. doi: 10.1007/s11999-010-1298-4.
Potter HG, Nestor BJ, Sofka CM, Ho ST, Peters LE, Salvati EA. Magnetic resonance imaging after total hip arthroplasty: evaluation of periprosthetic soft tissue. J Bone Joint Surg Am. 2004;86-A(9):1947–54.
Reing CM, Richin PF, Kenmore PI. Differential bone-scanning in the evaluation ofa painful total joint replacement. J Bone Joint Surg Am. 1979;61-A:933–6.
Scher DM, Pak K, Lonner JH, Finkel JE, Zuckerman JD, Di Cesare PE. The predictive value of indium-111 leukocytescans in the diagnosis of infected total hip, knee, or resection arthroplasties. Arthroplasty. 2000;15(3):295–300.
Spangehl MJ, Masterson E, Masri BA, O'Connell JX, Duncan CP. The role of intraoperative gram stain in the diagnosis of infection during revision total hip arthroplasty. J Arthroplasty. 1999;14:952–6.
Levine BR, Evans BG. Use of blood culture vial specimens in intraoperative detection of infection. Clin Orthop. 2001;382:222–31.
Morgan PM, Sharkey P, Ghanem E, Parvizi J, Clohisy JC, Burnett RS, Barrack RL. The value of intraoperative Gram stain in revision total knee arthroplasty. J Bone Joint Surg Am. 2009;91(9):2124–29. doi: 10.2106/JBJS.H.00853.
Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM, Rao N, Hanssen A, Wilson WR; Infectious Diseases Society of America. Executive summary: diagnosis and management of prosthetic jointinfection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013;56(1):1–10. doi: 10.1093/cid/cis966.
Larsen LH, Lange J, Xu Y, Schоnheyder HC. Optimizing culture methods for diagnosis of prosthetic joint infections: a summary of modifications and improvements reported since 1995. J Med Microbiol. 2012;61(Pt. 3):309–16. doi: 10.1099/jmm.0.035303-0.
Tunney MM, Patrick S, Gorman SP, Nixon JR, Anderson N, Davis RI, Hanna D, Ramage G. Improved detection of infection in hip replacements acurrently under estimated problem. J Bone Joint Surg Br. 1998;80:568–72.
Wong YC1, Lee QJ, Wai YL, Ng WF. Intraoperative frozen section for detecting active infection in failed hip and knee arthroplasties. J Arthroplasty. 2005;20(8):1015–20.
Francés Borrego A1, Martínez FM, Cebrian Parra JL, Grañeda DS, Crespo RG, López-Durán Stern L. Diagnosis of infection in hip and knee revision surgery: intraoperative frozen section analysis. Int Orthop. 2007;31(1):33–7.
Nunez LV, Buttaro MA, Morandi A, Pusso R, Piccaluga F. Frozen sections of samples taken intraoperatively for diagnosis of infection in revision hip surgery. Acta Orthop. 2007;78(2)226–30.
Copyright (c) 2016 Volodymyr Filipenko, Оleksey Marushchak, Stanislav Bondarenko
This work is licensed under a Creative Commons Attribution 4.0 International License.
The authors retain the right of authorship of their manuscript and pass the journal the right of the first publication of this article, which automatically become available after 6 months from the date of publication under the terms of Creative Commons Attribution License, which allows others to freely distribute the published manuscript with mandatory linking to authors of the original research and the first publication of this one in this journal.
Authors have the right to enter into a separate supplemental agreement on the additional non-exclusive distribution of manuscript in the form in which it was published by the journal (i.e. to put work in electronic storage of an institution or publish as a part of the book) while maintaining the reference to the first publication of the manuscript in this journal.
The editorial policy of the journal allows authors and encourages manuscript accommodation online (i.e. in storage of an institution or on the personal websites) as before submission of the manuscript to the editorial office, and during its editorial processing because it contributes to productive scientific discussion and positively affects the efficiency and dynamics of the published manuscript citation (see The Effect of Open Access).