Periprosthetic Knee Infection – Part 1: Risk Factors, Classification and Diagnosis

Abstract

Infection is one of the most feared complications in the postoperative period of knee arthroplasties. With the progressive aging of the population and the increased incidence of degenerative joint diseases, there is an exponential increase in the number of arthroplasties performed and, consequently, in the number of postoperative infections. The diagnosis of these should follow a hierarchical protocol, with well-defined criteria, which lead to diagnostic conclusion, thus guiding the most appropriate treatment. The aim of the present update article is to present the main risk factors, classifications and, mainly, to guide diagnostic investigation in an organized manner.

Keywords

arthroplasty, replacement, knee - surgical site infection - risk factors - diagnosis

Financial Support

There authors declare they have received no financial support from public, commercial, or non-profit sources.

Publikationsverlauf

Eingereicht: 06. November 2020

Angenommen: 17. Dezember 2020

Artikel online veröffentlicht:
27. Mai 2022

• Referências

• 1 Beard JR, Officer A, de Carvalho IA. et al. The World report on ageing and health: a policy framework for healthy ageing. Lancet 2016; 387 (10033): 2145-2154
• 2 Cross M, Smith E, Hoy D. et al. The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 2014; 73 (07) 1323-1330
• 3 Bozic KJ, Kurtz SM, Lau E. et al. The epidemiology of revision total knee arthroplasty in the United States. Clin Orthop Relat Res 2010; 468 (01) 45-51
• 4 Patel A, Pavlou G, Mújica-Mota RE, Toms AD. The epidemiology of revision total knee and hip arthroplasty in England and Wales: a comparative analysis with projections for the United States. A study using the National Joint Registry dataset. Bone Joint J 2015; 97-B [phone]
• 5 Delanois RE, Mistry JB, Gwam CU, Mohamed NS, Choksi US, Mont MA. Current Epidemiology of Revision Total Knee Arthroplasty in the United States. J Arthroplasty 2017; 32 (09) 2663-2668
• 6 Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 2007; 89 (04) 780-785
• 7 Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty 2012; 27 (8, Suppl): 61-5.e1
• 8 Hoy DG, Smith E, Cross M. et al. The global burden of musculoskeletal conditions for 2010: an overview of methods. Ann Rheum Dis 2014; 73 (06) 982-989
• 9 Kurtz SM, Lau EC, Ong KL, Adler EM, Kolisek FR, Manley MT. Which Clinical and Patient Factors Influence the National Economic Burden of Hospital Readmissions After Total Joint Arthroplasty?. Clin Orthop Relat Res 2017; 475 (12) 2926-2937
• 10 Evangelopoulos DS, Ahmad SS, Krismer AM. et al. Periprosthetic Infection: Major Cause of Early Failure of Primary and Revision Total Knee Arthroplasty. J Knee Surg 2019; 32 (10) 941-946
• 11 Kapadia BH, Banerjee S, Cherian JJ, Bozic KJ, Mont MA. The Economic Impact of Periprosthetic Infections After Total Hip Arthroplasty at a Specialized Tertiary-Care Center. J Arthroplasty 2016; 31 (07) 1422-1426
• 12 Akindolire J, Morcos MW, Marsh JD, Howard JL, Lanting BA, Vasarhelyi EM. The economic impact of periprosthetic infection in total hip arthroplasty. Can J Surg 2020; 63 (01) E52-E56
• 13 Parvizi J, Gehrke T. Anais do 2o Encontro do Consenso Internacional (ICM) em Infecção Musculoesqueletica [Internet]. ICM Philly. 2019 [citado 22 de março de 2020]. Disponível em: https://icmphilly.com/document/icm-document-translations/icm-document-portugues-brasil-translation/
• 14 Blanco JF, Díaz A, Melchor FR, da Casa C, Pescador D. Risk factors for periprosthetic joint infection after total knee arthroplasty. Arch Orthop Trauma Surg 2020; 140 (02) 239-245
• 15 Chen J, Cui Y, Li X. et al. Risk factors for deep infection after total knee arthroplasty: a meta-analysis. Arch Orthop Trauma Surg 2013; 133 (05) 675-687
• 16 Kunutsor SK, Whitehouse MR, Blom AW, Beswick AD. INFORM Team. Patient-Related Risk Factors for Periprosthetic Joint Infection after Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. PLoS One 2016; 11 (03) e0150866
• 17 Zhu Y, Zhang F, Chen W, Liu S, Zhang Q, Zhang Y. Risk factors for periprosthetic joint infection after total joint arthroplasty: a systematic review and meta-analysis. J Hosp Infect 2015; 89 (02) 82-89
• 18 Rotevatn TA, Bøggild H, Olesen CR. et al. Alcohol consumption and the risk of postoperative mortality and morbidity after primary hip or knee arthroplasty - A register-based cohort study. PLoS One 2017; 12 (03) e0173083
• 19 Nelson CL, Elkassabany NM, Kamath AF, Liu J. Low Albumin Levels, More Than Morbid Obesity, Are Associated With Complications After TKA. Clin Orthop Relat Res 2015; 473 (10) 3163-3172
• 20 Cordtz RL, Zobbe K, Højgaard P. et al. Predictors of revision, prosthetic joint infection and mortality following total hip or total knee arthroplasty in patients with rheumatoid arthritis: a nationwide cohort study using Danish healthcare registers. Ann Rheum Dis 2018; 77 (02) 281-288
• 21 Zainul-Abidin S, Amanatullah DF, Anderson MB. et al. General Assembly, Prevention, Host Related General: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S13-S35
• 22 Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. J Bone Joint Surg Am 2013; 95 (09) 775-782
• 23 Ares O, Arnold WV, Atilla B. et al. General Assembly, Prevention, Host Related Local: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S3-S12
• 24 Bala A, Penrose CT, Seyler TM, Mather 3rd RC, Wellman SS, Bolognesi MP. Outcomes after Total Knee Arthroplasty for post-traumatic arthritis. Knee 2015; 22 (06) 630-639
• 25 Aalirezaie A, Anoushiravani A, Cashman J. et al. General Assembly, Prevention, Host Risk Mitigation - Local Factors: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S37-S41
• 26 Bergen MA, Ryan SP, Hong CS, Bolognesi MP, Seyler TM. Conversion Total Knee Arthroplasty: A Distinct Surgical Procedure With Increased Resource Utilization. J Arthroplasty 2019; 34 (7S): S114-S120
• 27 Cancienne JM, Werner BC, Luetkemeyer LM, Browne JA. Does Timing of Previous Intra-Articular Steroid Injection Affect the Post-Operative Rate of Infection in Total Knee Arthroplasty?. J Arthroplasty 2015; 30 (11) 1879-1882
• 28 Richardson SS, Schairer WW, Sculco TP, Sculco PK. Comparison of Infection Risk with Corticosteroid or Hyaluronic Acid Injection Prior to Total Knee Arthroplasty. J Bone Joint Surg Am 2019; 101 (02) 112-118
• 29 Khanuja HS, Banerjee S, Sodhi GS, Mont MA. Do Prior Intra-Articular Corticosteroid Injections or Time of Administration Increase the Risks of Subsequent Periprosthetic Joint Infections after Total Knee Arthroplasty?. J Long Term Eff Med Implants 2016; 26 (03) 191-197
• 30 Kokubun BA, Manista GC, Courtney PM, Kearns SM, Levine BR. Intra-Articular Knee Injections Before Total Knee Arthroplasty: Outcomes and Complication Rates. J Arthroplasty 2017; 32 (06) 1798-1802
• 31 Cizmic Z, Feng JE, Huang R. et al. Hip and Knee Section, Prevention, Host Related: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S255-S270
• 32 Komnos GA, Manrique J, Goswami K. et al. Periprosthetic Joint Infection in Patients Who Have Multiple Prostheses in Place: What Should Be Done with the Silent Prosthetic Joints. J Bone Joint Surg Am 2020; 102 (13) 1160-1168
• 33 Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma 2018; 32 (Suppl. 01) S1-S170
• 34 Segawa H, Tsukayama DT, Kyle RF, Becker DA, Gustilo RB. Infection after total knee arthroplasty. A retrospective study of the treatment of eighty-one infections. J Bone Joint Surg Am 1999; 81 (10) 1434-1445
• 35 McPherson EJ, Tontz Jr W, Patzakis M. et al. Outcome of infected total knee utilizing a staging system for prosthetic joint infection. Am J Orthop 1999; 28 (03) 161-165
• 36 McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M. Periprosthetic total hip infection: outcomes using a staging system. Clin Orthop Relat Res 2002; (403) 8-15
• 37 Amanatullah D, Dennis D, Oltra EG. et al. Hip and Knee Section, Diagnosis, Definitions: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S329-S337
• 38 Alt V, Rupp M, Langer M, Baumann F, Trampuz A. Can the oncology classification system be used for prosthetic joint infection?: The PJI-TNM system. Bone Joint Res 2020; 9 (02) 79-81
• 39 Alt V, Rupp M, Langer M, Baumann F, Trampuz A. Infographic: Can the oncology classification system be used for prosthetic joint infection?: The PJI-TNM system. Bone Joint Res 2020; 9 (02) 77-78
• 40 Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40 (05) 373-383
• 41 Abdel Karim M, Andrawis J, Bengoa F. et al. Hip and Knee Section, Diagnosis, Algorithm: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S339-S350
• 42 Berbari E, Mabry T, Tsaras G. et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am 2010; 92 (11) 2102-2109
• 43 Shahi A, Kheir MM, Tarabichi M, Hosseinzadeh HRS, Tan TL, Parvizi J. Serum D-Dimer Test Is Promising for the Diagnosis of Periprosthetic Joint Infection and Timing of Reimplantation. J Bone Joint Surg Am 2017; 99 (17) 1419-1427
• 44 Huerfano E, Bautista M, Huerfano M, Bonilla G, Llinas A. Screening for Infection Before Revision Hip Arthroplasty: A Meta-analysis of Likelihood Ratios of Erythrocyte Sedimentation Rate and Serum C-reactive Protein Levels. J Am Acad Orthop Surg 2017; 25 (12) 809-817
• 45 Barretto JM, Loures FB, Albuquerque RS, Bezerra FD, Faro RV, Cavanellas NT. Evaluation of serum levels of C-reactive protein after total knee arthroplasty. Rev Bras Ortop 2017; 52 (02) 176-181
• 46 Lee YS, Lee YK, Han SB, Nam CH, Parvizi J, Koo KH. Natural progress of D-dimer following total joint arthroplasty: a baseline for the diagnosis of the early postoperative infection. J Orthop Surg Res 2018; 13 (01) 36
• 47 Cipriano CA, Brown NM, Michael AM, Moric M, Sporer SM, Della Valle CJ. Serum and synovial fluid analysis for diagnosing chronic periprosthetic infection in patients with inflammatory arthritis. J Bone Joint Surg Am 2012; 94 (07) 594-600
• 48 Shahi A, Deirmengian C, Higuera C. et al. Premature Therapeutic Antimicrobial Treatments Can Compromise the Diagnosis of Late Periprosthetic Joint Infection. Clin Orthop Relat Res 2015; 473 (07) 2244-2249
• 49 Yui JC, Preskill C, Greenlund LS. Arthrocentesis and Joint Injection in Patients Receiving Direct Oral Anticoagulants. Mayo Clin Proc 2017; 92 (08) 1223-1226
• 50 Yoon HK, Cho SH, Lee DY. et al. A Review of the Literature on Culture-Negative Periprosthetic Joint Infection: Epidemiology, Diagnosis and Treatment. Knee Surg Relat Res 2017; 29 (03) 155-164
• 51 Gehrke T, Lausmann C, Citak M, Bonanzinga T, Frommelt L, Zahar A. The Accuracy of the Alpha Defensin Lateral Flow Device for Diagnosis of Periprosthetic Joint Infection: Comparison with a Gold Standard. J Bone Joint Surg Am 2018; 100 (01) 42-48
• 52 Frangiamore SJ, Gajewski ND, Saleh A, Farias-Kovac M, Barsoum WK, Higuera CA. α-Defensin Accuracy to Diagnose Periprosthetic Joint Infection-Best Available Test?. J Arthroplasty 2016; 31 (02) 456-460
• 53 Bauer TW, Bedair H, Creech JD. et al. Hip and Knee Section, Diagnosis, Laboratory Tests: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S351-S359
• 54 Shahi A, Parvizi J, Kazarian GS. et al. The Alpha-defensin Test for Periprosthetic Joint Infections Is Not Affected by Prior Antibiotic Administration. Clin Orthop Relat Res 2016; 474 (07) 1610-1615
• 55 Shahi A, Alvand A, Ghanem E, Restrepo C, Parvizi J. The Leukocyte Esterase Test for Periprosthetic Joint Infection Is Not Affected by Prior Antibiotic Administration. J Bone Joint Surg Am 2019; 101 (08) 739-744
• 56 Li X, Li R, Ni M. et al. Leukocyte Esterase Strip Test: A Rapid and Reliable Method for the Diagnosis of Infections in Arthroplasty. Orthopedics 2018; 41 (02) e189-e193
• 57 Diaz-Ledezma C, Espinosa-Mendoza R, Gallo J. et al. General Assembly, Diagnosis, Imaging: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty 2019; 34 (2S): S215-S223
• 58 Springer BD. The Diagnosis of Periprosthetic Joint Infection. J Arthroplasty 2015; 30 (06) 908-911
• 59 Della Valle C, Parvizi J, Bauer TW. et al; American Academy of Orthopaedic Surgeons. American Academy of Orthopaedic Surgeons clinical practice guideline on: the diagnosis of periprosthetic joint infections of the hip and knee. J Bone Joint Surg Am 2011; 93 (14) 1355-1357