The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria.
Parvizi J, Tan TL, Goswami K, et al. The Journal of arthroplasty 2018 · PMID 29551303 · doi:10.1016/j.arth.2018.02.078
- Question
- Can a weighted, evidence-based scoring system improve on the 2011 MSIS criteria for diagnosing periprosthetic hip and knee infection?
- Design
- Multi-institutional derivation and external validation study of a scoring system for PJI built on the 2011 MSIS and 2013 ICM criteria.
- Patients
- Patients undergoing revision hip or knee arthroplasty for infection or aseptic failure.
- Intervention
- Weighted scoring of major and minor criteria (serum and synovial markers, culture, histology)
- Comparison
- 2011 MSIS and 2013 ICM definitions
- Primary outcome
- Sensitivity and specificity for PJI
- Key result
- Major criteria (sinus tract communicating with the joint, or two positive cultures of the same organism) confirm infection; otherwise weighted minor criteria (serum CRP, D-dimer, ESR; synovial WCC, leucocyte esterase, alpha-defensin, neutrophil percentage, synovial CRP) give a score where 6 or more indicates infection and 2-5 is inconclusive. The new definition showed higher sensitivity than the 2011 MSIS criteria with very high specificity.
- Limitations
- Derived largely from North American tertiary centres; several markers (alpha-defensin, D-dimer) are not universally available, and performance in early postoperative or low-grade infection is less certain.
- Impact on practice
- Widely used framework for diagnosing chronic PJI and the basis of many exam questions; emphasises joint aspiration with synovial WCC/neutrophil percentage before revision.