A) What is the optimal follow-up plan (i.e., schedule, exam maneuvers, labs, imaging) for patients being treated for periprosthetic joint infections (PJIs)? (B) How frequently should the infl ammatory biomarkers be measured after the resection arthroplasty performed as part of two-stage exchange?

Authors: Tiziana Ascione, Ali Oliashirazi, Yi Rong Zeng
RECOMMENDATION:
(A) At present, there is no consensus regarding the optimal follow-up schedule for patients being treated for PJIs and no specifi c research discussing this topic. In the absence of evidence, we recommend that the patients should be followed at 6 weeks postoperatively, 3 months, 6 months, 12 months, and annually thereafter, with adjustments being made based on individual circumstances. Infl ammatory
markers should be measured on a weekly basis after resection arthroplasty.

(B) As of now there is no study to assess the frequency with which the biomarkers need to be checked during the course of a two-stage exchange for PJIs. Most of the available studies have checked the available diagnostic batt ery of the tests, including serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as well as synovial fl uid white blood cell (WBC) count, polymorphonuclear (PMN) and leucocyte esterase (LE) at least once prior to the second stage (reimplantation). However, there is no unifi ed protocol that provides recommendations on the timing of these tests. Future studies in this field are required to guide the orthopaedic community and help form a consensus.
LEVEL OF EVIDENCE: (A) Consensus, (B) Consensus
DELEGATE VOTE: Agree: 85%, Disagree: 7%, Abstain: 8% (Super Majority, Strong Consensus)

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