How accurate are orthopedic surgeons in diagnosing periprosthetic joint infection after total knee arthroplasty?: A multicenter study.
BACKGROUND
The lack of standardized diagnostic criteria for periprosthetic joint infection (PJI) poses a challenge to accurate diagnosis of PJI. Recently, the Musculoskeletal Infection Society (MSIS) proposed diagnostic criteria for PJI. However, it is not known how well these proposed criteria accommodate real clinical scenarios. We determined what proportion of patients satisfied the MSIS criteria, and if MSIS criteria were not met, what other rationales were used to diagnose PJI.


METHODS
We retrospectively reviewed the records of 303 patients who underwent two-stage exchange arthroplasty for treatment of PJI of the knee at 17 institutions. The rationale for making the diagnosis of PJI was also recorded, if the case did not meet the MSIS criteria. In addition, detailed information about isolated microorganisms were gathered.


RESULTS
Among the 303 patients, 198 met the diagnostic criteria proposed by MSIS. Among the 105 patients who did not meet the MSIS criteria, 88% met two or three minor criteria; however joint fluid analysis or histologic analysis was not performed in 85% of these 105 patients. The most common rationale for the diagnosis of PJI was the presence of abnormal physical findings. Microorganisms were identified in only 52% of all patients; the most common organism was coagulase-negative Staphylococcus.


CONCLUSIONS
The diagnosis of PJI was based on clinical suspicion in approximately one-third of cases. In this series, joint aspiration or histological analysis was not performed in a large number of patients. Thus, surgeons should perform joint fluid and histologic analysis to assure the accuracy of PJI diagnosis.
Department of Orthopaedics, Seoul St. Mary's Hospital, Seoul 137-701, Republic of Korea; Department of Orthopaedics, The Catholic University of Korea, College of Medicine, Seoul 137-701, Republic of Korea. Electronic address: hinman74@naver.com.
In Jun
IJ
Koh
Department of Orthopaedics, Asan Medical Center, Ulsan University School of Medicine, Seoul 138-736, Republic of Korea. Electronic address: wscho@amc.seoul.kr.
Woo-Shin
WS
Cho
Department of Orthopaedics, The Catholic University of Korea, College of Medicine, Seoul 137-701, Republic of Korea; Department of Orthopaedics, St Paul's Hospital, Seoul 130-709, Republic of Korea. Electronic address: nychoimay@yahoo.co.kr.
Nam Yong
NY
Choi
Department of Orthopaedics, The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. Electronic address: parvj@aol.com.
Javad
J
Parvizi
Joint Reconstruction Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do 463-707, Republic of Korea; Department of Orthopaedics, Seoul National University College of Medicine, Seoul 110-799, Republic of Korea. Electronic address: osktk@snubh.org.
Tae Kyun
TK
Kim
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D002983:Clinical Competence; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007720:Knee Prosthesis / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D066231:Surgeons / Q000592:standards*
Diagnostic criteria; Musculoskeletal Infection Society; Periprosthetic joint infection; Total knee arthroplasty