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
- What evidence-based criteria best diagnose periprosthetic joint infection after hip or knee replacement?
- Design
- Multi-institutional development and validation of a weighted scoring system.
- Patients
- Patients undergoing revision hip or knee arthroplasty for infection or aseptic failure.
- Intervention
- Weighted criteria using serum markers (CRP, D-dimer, ESR), synovial tests (white cell count, neutrophil percentage, leucocyte esterase, alpha-defensin) and intraoperative findings
- Comparison
- Previous MSIS definition
- Primary outcome
- Diagnostic sensitivity and specificity
- Key result
- Major criteria (two positive cultures of the same organism, or a sinus tract communicating with the joint) confirm infection, while a weighted minor-criteria score classifies cases as infected, inconclusive or not infected. The new definition outperformed the 2011 MSIS criteria.
- Limitations
- Derived in high-volume US centres, and some tests such as alpha-defensin are not universally available in the NHS.
- Impact on practice
- The standard framework for working up a painful hip replacement for infection, including aspiration before revision.