Diagnosis of Chronic Infection at Total Hip Arthroplasty Revision Is a Question of Definition

Purpose. Contradicting definitions of periprosthetic joint infection (PJI) are in use. Joint aspiration is performed before total hip arthroplasty (THA) revision. This study investigated the influence of PJI definition on PJI prevalence at THA revision. Test quality of prerevision aspiration was eva...

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Autores principales:	Sebastian Philipp Boelch, Kilian Rüeckl, Laura Elisa Streck, Viktoria Szewczykowski, Manuel Weißenberger, Axel Jakuscheit, Maximilian Rudert
Formato:	article
Lenguaje:	EN
Publicado:	Hindawi Limited 2021
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/70f792227b6a4e7480882a1e5e1379fe
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spelling	oai:doaj.org-article:70f792227b6a4e7480882a1e5e1379fe2021-11-29T00:56:39ZDiagnosis of Chronic Infection at Total Hip Arthroplasty Revision Is a Question of Definition2314-614110.1155/2021/8442435https://doaj.org/article/70f792227b6a4e7480882a1e5e1379fe2021-01-01T00:00:00Zhttp://dx.doi.org/10.1155/2021/8442435https://doaj.org/toc/2314-6141Purpose. Contradicting definitions of periprosthetic joint infection (PJI) are in use. Joint aspiration is performed before total hip arthroplasty (THA) revision. This study investigated the influence of PJI definition on PJI prevalence at THA revision. Test quality of prerevision aspiration was evaluated for the different PJI definitions. Methods. 256 THA revisions were retrospectively classified to be infected or not infected. Classification was performed according to the 4 different definitions proposed by the Musculoskeletal Infection Society (MSIS), the Infectious Diseases Society of America (IDSA), the International Consensus Meeting (ICM), and the European Bone and Joint Infection Society (EBJIS). Only chronic PJIs were included. Results. PJI prevalence at revision significantly correlated with the applied PJI definition (p=0.01, Cramer’s V=0.093). PJI prevalence was 20.7% for the MSIS, 25.4% for the ICM, 28.1% for the IDSA, and 32.0% for the EBJIS definition. For synovial fluid white blood cell count, the best ROC-AUC for predicting PJI was 0.953 in combination with the MSIS definition. Conclusion. PJI definition significantly influences the rate of diagnosed PJIs at THA revision. Synovial fluid white blood cell count is a reliable means to rule out PJI. In cases with a borderline high synovial white blood cell count before THA revision as the only sign of chronic PJI, an extended diagnostic work-up should be considered.Sebastian Philipp BoelchKilian RüecklLaura Elisa StreckViktoria SzewczykowskiManuel WeißenbergerAxel JakuscheitMaximilian RudertHindawi LimitedarticleMedicineRENBioMed Research International, Vol 2021 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Sebastian Philipp Boelch Kilian Rüeckl Laura Elisa Streck Viktoria Szewczykowski Manuel Weißenberger Axel Jakuscheit Maximilian Rudert Diagnosis of Chronic Infection at Total Hip Arthroplasty Revision Is a Question of Definition
description	Purpose. Contradicting definitions of periprosthetic joint infection (PJI) are in use. Joint aspiration is performed before total hip arthroplasty (THA) revision. This study investigated the influence of PJI definition on PJI prevalence at THA revision. Test quality of prerevision aspiration was evaluated for the different PJI definitions. Methods. 256 THA revisions were retrospectively classified to be infected or not infected. Classification was performed according to the 4 different definitions proposed by the Musculoskeletal Infection Society (MSIS), the Infectious Diseases Society of America (IDSA), the International Consensus Meeting (ICM), and the European Bone and Joint Infection Society (EBJIS). Only chronic PJIs were included. Results. PJI prevalence at revision significantly correlated with the applied PJI definition (p=0.01, Cramer’s V=0.093). PJI prevalence was 20.7% for the MSIS, 25.4% for the ICM, 28.1% for the IDSA, and 32.0% for the EBJIS definition. For synovial fluid white blood cell count, the best ROC-AUC for predicting PJI was 0.953 in combination with the MSIS definition. Conclusion. PJI definition significantly influences the rate of diagnosed PJIs at THA revision. Synovial fluid white blood cell count is a reliable means to rule out PJI. In cases with a borderline high synovial white blood cell count before THA revision as the only sign of chronic PJI, an extended diagnostic work-up should be considered.
format	article
author	Sebastian Philipp Boelch Kilian Rüeckl Laura Elisa Streck Viktoria Szewczykowski Manuel Weißenberger Axel Jakuscheit Maximilian Rudert
author_facet	Sebastian Philipp Boelch Kilian Rüeckl Laura Elisa Streck Viktoria Szewczykowski Manuel Weißenberger Axel Jakuscheit Maximilian Rudert
author_sort	Sebastian Philipp Boelch
title	Diagnosis of Chronic Infection at Total Hip Arthroplasty Revision Is a Question of Definition
title_short	Diagnosis of Chronic Infection at Total Hip Arthroplasty Revision Is a Question of Definition
title_full	Diagnosis of Chronic Infection at Total Hip Arthroplasty Revision Is a Question of Definition
title_fullStr	Diagnosis of Chronic Infection at Total Hip Arthroplasty Revision Is a Question of Definition
title_full_unstemmed	Diagnosis of Chronic Infection at Total Hip Arthroplasty Revision Is a Question of Definition
title_sort	diagnosis of chronic infection at total hip arthroplasty revision is a question of definition
publisher	Hindawi Limited
publishDate	2021
url	https://doaj.org/article/70f792227b6a4e7480882a1e5e1379fe
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Diagnosis of Chronic Infection at Total Hip Arthroplasty Revision Is a Question of Definition

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