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Research Article
Katrin Osmanski-Zenk
Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock
Corresponding Author
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Since there are no national or international algorithms there are different procedures for both, the diagnosis and the therapy of a periprosthetic joint infection (PJI). Therefore, the present paper evaluates the respective protocols from different centres on the basis of an EndoCert questionnaire to treat PJI in certified total joint replacement centres (EPZ).
Materials and methods
A questionnaire was developed in cooperation with the EndoCert Certification Commission to survey the principles to treat septic revision arthroplasties in EPZ including questions on various treatment options: prosthesis preserving procedures (DAIR - Debridement, antibiotics, irrigation, and retention of the prosthesis), one-stage revision, two-stage revision, removal of the endoprosthesis and sampling prior to reimplantation. All certified EPZ were included (n = 504). The results of the current survey 2020 were compared to those of a previous analysis.
Results
The number of centres that performed DAIR up to a maximum of 4 weeks and more than 10 weeks after index surgery has clearly decreased since 2015, while the number of centres that provided a one-stage revision as a treatment option has increased (hip: +6.3%; knee: +6.6%). The majority of the centres (73.2%) indicated a 4-8 week period as the interval between prosthesis removal and reimplantation for two-stage replacement for both, hip and knee revisions. Amongst centres with a higher number of revision surgeries (>200 revisions/year), there were even more that opted for the 4-8 week period (92.3%). The Girdlestone situation, but also metal-based spacers with/without reinforcement with antibiotic-containing cement, are less frequently used. When exchanging knee replacements, there was a clear trend towards cemented anchoring, whereas cementless anchorage was preferred for hip replacements. Overall, the number of EPZ with a standardised protocol for the procedure continues to increase. In addition, more samples for microbiological testing are taken when removing the endoprosthesis, 72% of the centres take 5 or more samples.
Conclusion
While there was a trend towards standardised therapeutic algorithms for PJI with more uniform choices among the centres in 2020 compared to 2015, the treatment often remains an individual decision. However, since a consistent treatment regime is of vital importance with an expected rise of total numbers of revision arthroplasties, uniform definitions with regard to comparability and standardisation are necessary for the further development of the EndoCert system.
Keywords
EndoCert, therapeutic algorithm, periprosthetic joint infection, anchoring techniques, international consensus conference
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Competing interest reported. K. Osmanski-Zenk is financed by a third-party project of EndoCert GmbH, which is a wholly-owned subsidiary of the German Society for Orthopaedics and Orthopaedic Surgery. A. Klinder and Ch. Rimke declare that there is no conflict of interest. B. Kladny is the General Secretary of the German Society for Orthopaedics and Orthopaedic Surgery (DGOOC). D. C. Wirtz, C. H. Lohmann, H. Haas and W. Mittelmeier are honorary members of the certification commission of EndoCert GmbH.
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Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 22 Feb, 2021
No community comments so far
Editorial decision: Major revision
On 01 Jun, 2021
Reviews received
Received 19 May, 2021
Reviewers agreed
On 03 May, 2021
Reviewers invited
Invitations sent on 19 Feb, 2021
Editor assigned
On 19 Feb, 2021
Editor invited
On 19 Feb, 2021
Submission checks complete
On 19 Feb, 2021
First submitted
On 27 Jan, 2021
Metrics
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PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
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This preprint is under consideration at BMC Musculoskeletal Disorders. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Katrin Osmanski-Zenk
Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 22 Feb, 2021
No community comments so far
Editorial decision: Major revision
On 01 Jun, 2021
Reviews received
Received 19 May, 2021
Reviewers agreed
On 03 May, 2021
Reviewers invited
Invitations sent on 19 Feb, 2021
Editor assigned
On 19 Feb, 2021
Editor invited
On 19 Feb, 2021
Submission checks complete
On 19 Feb, 2021
First submitted
On 27 Jan, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Orthopedics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Since there are no national or international algorithms there are different procedures for both, the diagnosis and the therapy of a periprosthetic joint infection (PJI). Therefore, the present paper evaluates the respective protocols from different centres on the basis of an EndoCert questionnaire to treat PJI in certified total joint replacement centres (EPZ).
Materials and methods
A questionnaire was developed in cooperation with the EndoCert Certification Commission to survey the principles to treat septic revision arthroplasties in EPZ including questions on various treatment options: prosthesis preserving procedures (DAIR - Debridement, antibiotics, irrigation, and retention of the prosthesis), one-stage revision, two-stage revision, removal of the endoprosthesis and sampling prior to reimplantation. All certified EPZ were included (n = 504). The results of the current survey 2020 were compared to those of a previous analysis.
Results
The number of centres that performed DAIR up to a maximum of 4 weeks and more than 10 weeks after index surgery has clearly decreased since 2015, while the number of centres that provided a one-stage revision as a treatment option has increased (hip: +6.3%; knee: +6.6%). The majority of the centres (73.2%) indicated a 4-8 week period as the interval between prosthesis removal and reimplantation for two-stage replacement for both, hip and knee revisions. Amongst centres with a higher number of revision surgeries (>200 revisions/year), there were even more that opted for the 4-8 week period (92.3%). The Girdlestone situation, but also metal-based spacers with/without reinforcement with antibiotic-containing cement, are less frequently used. When exchanging knee replacements, there was a clear trend towards cemented anchoring, whereas cementless anchorage was preferred for hip replacements. Overall, the number of EPZ with a standardised protocol for the procedure continues to increase. In addition, more samples for microbiological testing are taken when removing the endoprosthesis, 72% of the centres take 5 or more samples.
Conclusion
While there was a trend towards standardised therapeutic algorithms for PJI with more uniform choices among the centres in 2020 compared to 2015, the treatment often remains an individual decision. However, since a consistent treatment regime is of vital importance with an expected rise of total numbers of revision arthroplasties, uniform definitions with regard to comparability and standardisation are necessary for the further development of the EndoCert system.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Competing interest reported. K. Osmanski-Zenk is financed by a third-party project of EndoCert GmbH, which is a wholly-owned subsidiary of the German Society for Orthopaedics and Orthopaedic Surgery. A. Klinder and Ch. Rimke declare that there is no conflict of interest. B. Kladny is the General Secretary of the German Society for Orthopaedics and Orthopaedic Surgery (DGOOC). D. C. Wirtz, C. H. Lohmann, H. Haas and W. Mittelmeier are honorary members of the certification commission of EndoCert GmbH.
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