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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: Boelch, Sebastian Philipp, Rüeckl, Kilian, Streck, Laura Elisa, Szewczykowski, Viktoria, Weißenberger, Manuel, Jakuscheit, Axel, Rudert, Maximilian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8626185/
https://www.ncbi.nlm.nih.gov/pubmed/34840982
http://dx.doi.org/10.1155/2021/8442435
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author Boelch, Sebastian Philipp
Rüeckl, Kilian
Streck, Laura Elisa
Szewczykowski, Viktoria
Weißenberger, Manuel
Jakuscheit, Axel
Rudert, Maximilian
author_facet Boelch, Sebastian Philipp
Rüeckl, Kilian
Streck, Laura Elisa
Szewczykowski, Viktoria
Weißenberger, Manuel
Jakuscheit, Axel
Rudert, Maximilian
author_sort Boelch, Sebastian Philipp
collection PubMed
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.
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spelling pubmed-86261852021-11-27 Diagnosis of Chronic Infection at Total Hip Arthroplasty Revision Is a Question of Definition Boelch, Sebastian Philipp Rüeckl, Kilian Streck, Laura Elisa Szewczykowski, Viktoria Weißenberger, Manuel Jakuscheit, Axel Rudert, Maximilian Biomed Res Int Research Article 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. Hindawi 2021-11-19 /pmc/articles/PMC8626185/ /pubmed/34840982 http://dx.doi.org/10.1155/2021/8442435 Text en Copyright © 2021 Sebastian Philipp Boelch et al. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Boelch, Sebastian Philipp
Rüeckl, Kilian
Streck, Laura Elisa
Szewczykowski, Viktoria
Weißenberger, Manuel
Jakuscheit, Axel
Rudert, Maximilian
Diagnosis of Chronic Infection at Total Hip Arthroplasty Revision Is a Question of Definition
title 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_short 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
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8626185/
https://www.ncbi.nlm.nih.gov/pubmed/34840982
http://dx.doi.org/10.1155/2021/8442435
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