Paper of the week:  The 2018 new definition of periprosthetic joint infection improves the diagnostic efficiency in the Chinese population. Haitao Guan, Jun Fu, Xiang Li, Wei Chai, Libo Hao, Rui Li, Jing Zhao, and Jiying Chen. J Orthop Surg Res. 2019; 14: 151. Published online 2019 May 24. doi: 10.1186/s13018-019-1185-y

Summary by Dr Sreeram Penna

The purpose of this retrospective study was to validate the 2018 ICM criteria on Chinese patients that underwent revision for total hip arthroplasty (THA) and total knee arthroplasty (TKA) for the periprosthetic joint infection (PJI) or aseptic loosening. This study excluded patients with antibiotic-loaded cement spacer in their joint at admission, patients who had a long antibiotic history prior to surgery, and those who had multiple prior surgical procedures. Patients were classified in PJI or not using major criteria in MSIS, 2013 ICM, and 2018 ICM criteria. Researchers then compared minor criteria between the 2018 ICM definition and the 2013 ICM and IDSA criteria.

The study cohort included 98 PJI cases and 168 aseptic revision patients. Statistical analysis showed that overall sensitivity, specificity, positive predictive value, and negative predictive value of 2018 ICM criteria was 94.9%, 95.2%, 92.1%, and 96.1% respectively. For 2013 ICM criteria the results were 53.1%, 98.4%, 96.3%, and 78.8% respectively. For IDSA criteria results were 72.4%, 86.7%, 76.3% and 84.1% respectively.

Overall researchers conclude that 2018 ICM criteria are applicable in the Chinese population. Also, the 2018 ICM criteria was shown to have higher sensitivity compared to the 2013 ICM criteria and IDSA criteria for the diagnosis of PJI.