What is the definition of success of surgical treatment of a patient with a periprosthetic joint infection (PJI)? What clinical, operative, microbiological and functional metrics should be considered?

Authors: Yale J. Fillingham, Craig J. Della Valle, Linda I. Suleiman, Bryan D. Springer, Thorsten Gehrke, Stefano Bini, John Segreti, Antonia F. Chen, Karan Goswami, Timothy L. Tan, Noam Shohat, Claudio Diaz-Ledezma, Adam J. Schwartz, Javad Parvizi

RECOMMENDATION: The treatment of PJIs typically does not have a dichotomous outcome. More commonly, the result is a gradient of success or failure. As such, the outcome-reporting tool has been organized into four tiers with each tier encompassing different levels of perceived success or failure. The outcomes reporting for the treatment of PJIs are the following (definitions regarding items within each tier are explained in the rationale section):
Tier 1. Infection control with no continued antibiotic therapy
Tier 2. Infection control with patient on suppressive antibiotic therapy
Tier 3. Need for reoperation and/or revision and/or spacer retention (assigned to subgroups of A, B, C, D, E, and F
based on the type of reoperation)
A. Aseptic revision > 1 year from initiation of PJI treatment
B. Septic revision (including debridement, antibiotic and implant retention (DAIR)) > 1 year from initiation of PJI treatment
(excluding amputation, resection arthroplasty and fusion)
C. Aseptic revision ≤ 1 year from initiation of PJI treatment
D. Septic revision (including DAIR) ≤ 1 year from initiation of PJI treatment (excluding amputation, resection arthroplasty, and fusion)
E. Amputation, resection arthroplasty, or fusion
F. Retained spacer
Tier 4. Death (assigned to subgroups A or B)
A. Death ≤ to 1 year from initiation of PJI treatment
B. Death > 1 year from initiation of PJI treatment

LEVEL OF EVIDENCE: Consensus

DELEGATE VOTE: Agree: 82%, Disagree: 14%, Abstain: 4% (Super Majority, Strong Consensus)