Advertisement for orthosearch.org.uk
Bone & Joint Research Logo

Receive monthly Table of Contents alerts from Bone & Joint Research

Comprehensive article alerts can be set up and managed through your account settings

View my account settings

Visit Bone & Joint Research at:

Loading...

Loading...

Open Access

Infographic

Periprosthetic joint infection

patients benefit from a multidisciplinary team approach



Download PDF

Periprosthetic joint infections (PJIs) are often difficult to treat. Therefore, we established a so-called “Limb Board (EB)”, a weekly collaborative case discussion round of all medical disciplines involved in the treatment. These include members of the department of trauma surgery, clinical microbiology, infectious diseases, diagnostic radiology, pathology, plastic and reconstructive surgery, vascular surgery, endocrinology, and psychosomatic medicine. During these meetings, each case is evaluated from all perspectives, optimal treatment strategies are developed for each individual patient based on collective expertise documented in the patient’s medical record.

To evaluate the effectiveness of such an interdisciplinary strategy, a retrospective cohort study of patients treated for PJI, grouped in cases discussed in the EB meeting and cases, which were not part of the EB, was conducted in a university hospital centre in Germany. Patient characteristics, and details of infections and treatment procedure, were retrieved with a follow-up of 12 months. Treatment success was defined based on the Delphi criteria.1 Amputation or a permanent Girdlestone situation were considered as treatment failure. Continuous parameters were compared by independent-samples t-test (significance level p < 0.05).

Neither sex, age, anatomical localization, Charlson Comorbidity Index (CCI), nor surgical procedure differed statistically significantly between the groups. The surgical revision rate, as well as the one-year mortality, was statistically significantly lower in EB patients compared to the control group. Furthermore, the EB group had a lower rate of recurrence of infection (p = 0.122) and reduced time between the first and second revision in cases of two-stage procedures (p = 0.164). Interestingly, even though not statistically significant, fewer patients were treated by a two-stage approach (25.0% vs 34.5%) and with a Girdlestone situation (5.0% vs 20.7%). Overall success rate was higher in the EB group (p = 0.164).

The results show that PJI patients significantly benefit from interdisciplinary case discussions and a personalized treatment regime. Interdisciplinary approaches should be implemented as standard care in trauma surgery as it is already common practice in oncology to further improve clinical outcomes of PJI.

Fig. 1


Markus Rupp. E-mail:

References

1. Diaz-Ledezma C , Higuera CA , Parvizi J . Success after treatment of periprosthetic joint infection: a Delphi-based international multidisciplinary consensus . Clin Orthop Relat Res . 2013 ; 471 ( 7 ): 2374 2382 . Crossref PubMed Google Scholar

Author contributions

N. Walter: Writing – original draft, Visualization.

M. Rupp: Conceptualization, Writing – review & editing.

S. Baertl: Visualization, Methodology.

T. P. Ziarko: Methodology, Investigation, Formal Analysis.

F. Hitzenbichler: Writing – review & editing.

S. Geis: Writing – review & editing.

C. Brochhausen: Writing – review & editing, Supervision.

V. Alt: Conceptualization, Writing – review & editing, Supervision.

Funding statement

The author(s) received no financial or material support for the research, authorship, and/or publication of this article.

Acknowledgements

We acknowledge the valuable work of all members of the "limb board" implemented at the University Medical Center Regensburg.

Ethical review statement

The institutional review board approved the performed study beforehand (20-1681-104).