Optimizing the detection of Prosthetic Joint Infection

Brenebel, I. (Ioan) (2015) Optimizing the detection of Prosthetic Joint Infection. thesis, Medicine.

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Abstract

Background: Osteoarthritis is painful degradation of a joint. Recent research shows that 10 – 12% of the adult working population has symptomatic osteoarthritis. Initially the treatment starts with analgesics and advances to intra-articular drug treatment. The only known curative treatment for osteoarthritis is prosthetic joint replacement. Hip and knee prostheses usually have to be revised after a decade, because of wear of the prosthesis. The need for revision surgery can be accelerated by different factors and complications. The most troublesome complication after total hip arthroplasty (THA), and total knee arthroplasty (TKA) is prosthetic joint infection (PJI). PJI has an incidence of 0.5 – 2.0% and can occur in different stages of recovery. Late onset PJIs, i.e. between 3 – 24 months after the operation, are often difficult to detect. These PJIs typically present after primary wound closure. They are frequently low grade infections, with nonspecific symptoms. PJIs cause local harm to the affected joint, but can also have systemic consequences and cause endocarditis. A PJI usually requires a different surgical approach from an aseptic reasons for revision surgery. A good initial diagnostic tool for the work-up is the Zimmerli infection score. This consists of a specific line of questions, physical examination, an x-ray, and blood tests. If based on the preliminary work-op a PJI is suspected, the physician needs additional tests to make sure his diagnosis is correct. Widely used are the bone scans and labeled leukocyte imaging. This research has three objectives. (1) To calculate the positive predictive value (PPV) and negative predictive value (NPV) of the bone scan and labelled leukocyte imaging. (2) To determine if there is a difference between the THA and TKA, PPV and NPV results for this protocol. (3) Determine if the PJIs that were missed by the bone scan and labelled leukocyte imaging are caused by a specific bacterial species. Methods: For this retrospective cohort study all THA and TKA revisions in the University Medical Center Groningen and Martini hospital between 2007 and 2012 were collected in a database. Information with regard to Zimmerli infection score, bone scan, and labelled leukocyte imaging were gathered. Results: The PPV and NPV of the Zimmerli infection score is 48,1% and 96,0%, for the bone scan these numbers are 22,5% and 93,8%, for the labelled leukocyte imaging it is 33,3% and 91,1%, and for the combined efforts represented by the preoperative cause for revision it is 65,9% and 98,2%. A significant difference was found between THA and TKA for the PPV of the Zimmerli infection score (p ≤ ,05), no other significant differences were found. Two out of 8 PJIs, that were missed by the bone scan, were because of Staph. aureus, 2 were culture negative, and the other 4 had different causative agents. The labelled leukocyte imaging missed 2 out of 5 PJIs because of coagulase-negative staphylococci, and one time because of Staph. epidermidis, the remaining 2 cases were culture negative PJIs. Conclusion: The Zimmerli infection score, bone scan, and labelled leukocyte imaging have a high NPV, but a low PPV. There is no noteworthy difference between THA and TKA for this protocol. Bacterial PJIs that were missed by bone scan and labelled leukocyte imaging did not differ substantially from the bacterial species the scans did pick up on, also the groups were too small to sustain a definitive conclusion.

Item Type:	Thesis (Thesis)
Supervisor name:	Begeleider: and Jutte, Dr. P. C. and Orthopedisch and chirurg and Rijksuniversiteit Groningen and Universitair Medisch Centrum and Groningen and Afdeling Orthopedie
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:40
Last Modified:	25 Jun 2020 10:40
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/169

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