Diagnosing periprosthetic joint infections a comparison of infection definitions: EBJIS 2021, ICM 2018, and IDSA 2013

• Published in: Bone & joint research Vol. 11; no. 9; pp. 608 - 618
• Main Authors: Sigmund, Irene K., Luger, Markus, Windhager, Reinhard, McNally, Martin A.
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone & Joint Surgery 01.09.2022; The British Editorial Society of Bone & Joint Surgery
• Subjects: Arthroplasty (hip); Arthroplasty (knee); Decision making; Diagnosis; Infection; Infection definition; Infections; Infectious diseases; Joint diseases; Medical diagnosis; Patients; Periprosthetic joint infection; revision arthroplasty; revision total hip arthroplasty; revision total knee arthroplasty
• ISSN: 2046-3758; 2046-3758
• DOI: 10.1302/2046-3758.119.BJR-2022-0078.R1

Aims This study evaluated the definitions developed by the European Bone and Joint Infection Society (EBJIS) 2021, the International Consensus Meeting (ICM) 2018, and the Infectious Diseases Society of America (IDSA) 2013, for the diagnosis of periprosthetic joint infection (PJI). Methods In this single-centre, retrospective analysis of prospectively collected data, patients with an indicated revision surgery after a total hip or knee arthroplasty were included between 2015 and 2020. A standardized diagnostic workup was performed, identifying the components of the EBJIS, ICM, and IDSA criteria in each patient. Results Of 206 included patients, 101 (49%) were diagnosed with PJI with the EBJIS definition. IDSA and ICM diagnosed 99 (48%) and 86 (42%) as infected, respectively. A total of 84 cases (41%) had an infection based on all three criteria. In 15 cases (n = 15/206; 7%), PJI was present when applying only the IDSA and EBJIS criteria. No infection was detected by one definition alone. Inconclusive diagnoses occurred more frequently with the ICM criteria (n = 30/206; 15%) compared to EBJIS (likely infections: n = 16/206; 8%) (p = 0.029). A better preoperative performance of the EBJIS definition was seen compared with the ICM and IDSA definitions (p < 0.001). Conclusion The novel EBJIS definition identified all PJIs diagnosed by any other criteria. Use of the EBJIS definition significantly reduced the number of uncertain diagnoses, allowing easier clinical decision-making. Cite this article: Bone Joint Res 2022;11(9):608–618.