The 2018 New Definition of Periprosthetic Joint Infection is Valuable for Diagnosis of Persistent Infection at Reimplantation in Patients without Synovial Fluid
2020
Abstract Background Diagnosis of persistent infection at reimplantation of two-stage exchange revision is a challenging problem. The aim of our study was to: evaluate the performance of the 2018 new definition and Musculoskeletal Infection Society (MSIS) criteria in determining the persistent infection at reimplantation in patients without synovial fluid. Methods We retrospectively reviewed 150 patients underwent two-stage exchange revision from 2014 to 2018. Two models were used to define persistent infection. Model 1: identical major criteria of the MSIS criteria and new definition; Model 2: identical major criteria of two criteria and/or subsequent infection after reimplantation. The predictive accuracy of the new definition and MSIS criteria was compared by using receiver operating characteristic (ROC) curves. Results The ROC curves showed that the new definition had good performance in determining the persistent infection, with the area under the curve (AUC) of 0.871 in model 1 and 0.835 in model 2. The optimal threshold for aggregate scores in new definition was 4. The MSIS criteria had limited diagnostic value in both model 1 (AUC=0.708) and model 2 (AUC=0.664). In model 1, the sensitivity and specificity were 86.96% and 84.25% in new definition, and 47.83% and 93.70% in MSIS criteria in patients without synovial fluid. In model 2, the sensitivity and specificity of were 78.57% and 85.25% in new definition, and 39.29% and 93.44% in MSIS criteria. Conclusion The 2018 new definition of PJI is valuable in the diagnosis of persistent infection, which can improve diagnostic accuracy compared with the MSIS criteria in patients without synovial fluid.
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