谈谈关节假体周围感染的诊断问题
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摘要
<正>关节假体周围感染(periprosthetic joint infection,PJI)是关节置换术后灾难性的并发症。据估计,1%～3%的初次置换患者以及3%～5%的翻修患者会发生PJI ~([1-5])。根据最新文献报道,感染是膝关节置换术后翻修的首要原因~([6-7]),是髋关节置换术后翻修的第三或第四大原因~([7-8])。随着关节置换手术量的逐年增大,关节翻修将是未来关节外科手术的重要组成部分,PJI的病例量也必将随之逐年上升。预计到2020年,美国感染
Periprosthetic joint infection (PJI) is a catastrophic complication after joint replacement. Correct diagnosis is a key step for PJI treatment. At present, American association of physicians (AAOS), musculoskeletal infection association (MSIS), American association of infectious diseases (IDSA), ICM on PJI and other international organizations have given their own diagnostic criteria. In September 2018, the second ICM was held again in Philadelphia, and further discussions were conducted on relevant issues. D-dimer, α-defensin and other indicators were added in the new diagnostic criteria. According to the current guidelines, the diagnosis process of PJI can still be divided into symptom and sign assessment, peripheral blood test, diagnostic joint aspiration and intraoperative relative examination. In the future, molecular diagnostic techniques represented by next generation sequencing (NGS) may play an important role. In addition, future studies may focus on the exploration of novel biomarkers and the realization of convenient and rapid diagnosis. This article will review the available diagnostic methods and novel development in the diagnosis of periprosthetic joint infection combined with the 2013 and 2018 ICM criteria.
Periprosthetic joint infection (PJI) is a catastrophic complication after joint replacement. Correct diagnosis is a key step for PJI treatment. At present, American association of physicians (AAOS), musculoskeletal infection association (MSIS), American association of infectious diseases (IDSA), ICM on PJI and other international organizations have given their own diagnostic criteria. In September 2018, the second ICM was held again in Philadelphia, and further discussions were conducted on relevant issues. D-dimer, α-defensin and other indicators were added in the new diagnostic criteria. According to the current guidelines, the diagnosis process of PJI can still be divided into symptom and sign assessment, peripheral blood test, diagnostic joint aspiration and intraoperative relative examination. In the future, molecular diagnostic techniques represented by next generation sequencing (NGS) may play an important role. In addition, future studies may focus on the exploration of novel biomarkers and the realization of convenient and rapid diagnosis. This article will review the available diagnostic methods and novel development in the diagnosis of periprosthetic joint infection combined with the 2013 and 2018 ICM criteria.
引文
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[2]Huotari K,Peltola M,J?msen E.The incidence of late prosthetic joint infections:a registry-based study of 112,708 primary hip and knee replacements[J].Acta Orthop,2015,86(3):321-325.
[3]Phillips JE,Crane TP,Noy M,et al.The incidence of deep prosthetic infections in a specialist orthopaedic hospital:a 15-year prospective survey[J].J Bone Joint Surg Bri,2006,88(7):943-948.
[4]Kurtz SM,Lau E,Schmier J,et al.Infection burden for hip and knee arthroplasty in the United States[J].J Arthroplasty,2008,23(7):984-991.
[5]Jamsen E,Varonen M,Huhtala H,et al.Incidence of prosthetic joint infections after primary knee arthroplasty[J].J Arthroplasty,2010,25(1):87-92.
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[35]Zhao X,Guo C,Zhao GS,et al.Ten versus five polymorphonuclear leukocytes as threshold in frozen section tests for periprosthetic infection:a meta-analysis[J].J Arthroplasty,2013,28(6):913-917.
[36]Bori G,McNally MA,Athanasou N.Histopathology in periprosthetic joint infection:when will the morphomolecular diagnosis be a reality[J]?Biomed Res Int,2018,2018:1412701.
[37]Bemer P,Leger J,Milin S,et al.Histopathological diagnosis of prosthetic joint infection:does a threshold of 23 neutrophils do better than classification of the periprosthetic membrane in a prospective multicenter study[J]?J Clin Microbiol,2018,56(9).
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[39]Abdel MP,Akgun D,Akin G,et al.Hip and knee section,diagnosis,pathogen isolation,culture:proceedings of international consensus on orthopedic infections[J].J Arthroplasty,2019,34(2s):S361-367.
[40]Trampuz A,Piper KE,Jacobson MJ,et al.Sonication of removed hip and knee prostheses for diagnosis of infection[J].New Eng J Med,2007,357(7):654-663.
[41]Li C,Renz N,Thies CO,et al.Meta-analysis of sonicate fluid in blood culture bottles for diagnosing periprosthetic joint infection[J].J Bone Jt Infect,2018,3(5):273-279.
[42]Abdel Karim M,Andrawis J,Bengoa F,et al.Hip and knee section,diagnosis,algorithm:proceedings of international consensus on orthopedic infections[J].J Arthroplasty,2019,34(2s):S339-350.
[43]Tarabichi M,Shohat N,Goswami K,et al.Diagnosis of periprosthetic joint infection:the potential of next-generation sequencing[J].J Bone Joint Surg Am,2018,100(2):147-154.
[44]Tarabichi M,Shohat N,Goswami K,et al.Can next generation sequencing play a role in detecting pathogens in synovial fluid[J]?Bone Joint J,2018,100-B(2):127-133.
[45]Street TL,Sanderson ND,Atkins BL,et al.Molecular diagnosis of orthopedic-device-related infection directly from sonication fluid by metagenomic sequencing[J].J Clin Microbiol,2017,55(8):2334-2347.
[46]Thoendel MJ,Jeraldo PR,Greenwood-Quaintance KE,et al.Identification of prosthetic joint infection pathogens using a shotgun metagenomics approach[J].Clin Infect Dis,2018,67(9):1333-1338.
[47]Ivy MI,Thoendel MJ,Jeraldo PR,et al.Direct detection and identification of prosthetic joint infection pathogens in synovial fluid by metagenomic shotgun sequencing[J].J Clin Microbiol,2018,56(9).
[48]Xie K,Dai K,Qu X,et al.Serum and synovial fluid interleukin-6 for the diagnosis of periprosthetic joint infection[J].Sci Rep,2017,7(1):1496.
[49]Klim SM,Amerstorfer F,Gruber G,et al.Fibrinogen-a practical and cost efficient biomarker for detecting periprosthetic joint infection[J].Sci Rep,2018,8(1):8802.
[50]Marazzi MG,Randelli F,Brioschi M,et al.Preseason:A potential biomarker of PJI?A comparative analysis with known and new infection biomarkers[J].Int J Immunopathol Pharmacol,2017,394632017749356.
[51]Yoon JR,Yang SH,Shin YS.Diagnostic accuracy of interleukin-6 and procalcitonin in patients with periprosthetic joint infection:a systematic review and meta-analysis[J].Int Orthop,2018,42(6):1213-1226.
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[2]Huotari K,Peltola M,J?msen E.The incidence of late prosthetic joint infections:a registry-based study of 112,708 primary hip and knee replacements[J].Acta Orthop,2015,86(3):321-325.
[3]Phillips JE,Crane TP,Noy M,et al.The incidence of deep prosthetic infections in a specialist orthopaedic hospital:a 15-year prospective survey[J].J Bone Joint Surg Bri,2006,88(7):943-948.
[4]Kurtz SM,Lau E,Schmier J,et al.Infection burden for hip and knee arthroplasty in the United States[J].J Arthroplasty,2008,23(7):984-991.
[5]Jamsen E,Varonen M,Huhtala H,et al.Incidence of prosthetic joint infections after primary knee arthroplasty[J].J Arthroplasty,2010,25(1):87-92.
[6]Delanois RE,Mistry JB,Gwam CU,et al.Current Epidemiology of revision total knee arthroplasty in the united states[J].J Arthroplasty,2017.
[7]Kamath AF,Ong KL,Lau E,et al.Quantifying the burden of revision total joint arthroplasty for periprosthetic infection[J].J Arthroplasty,2015,30(9):1492-1497.
[8]Gwam CU,Mistry JB,Mohamed NS,et al.Current epidemiology of revision total hip arthroplasty in the united states:national inpatient sample 2009 to 2013[J].J Arthroplasty,2017,32(7):2088-2092.
[9]Della Valle C,Parvizi J,Bauer TW,et al.Diagnosis of periprosthetic joint infections of the hip and knee[J].J Am Acad Orthop Surg,2010,18(12):760-770.
[10]Corvec S,Portillo ME,Pasticci BM,et al.Epidemiology and new developments in the diagnosis of prosthetic joint infection[J].Int J Artif Organs,2012,35(10):923-934.
[11]Osmon DR,Berbari EF,Berendt AR,et al.Diagnosis and management of prosthetic joint infection:clinical practice guidelines by the infectious diseases society of America[J].Clin Infect Dis,2013,56(1):e1-25.
[12]Parvizi J,Gehrke T.Definition of periprosthetic joint infection[J].J Arthroplasty,2014,29(7):1331.
[13]Shohat N,Bauer T,Buttaro M,et al.Hip and knee section,what is the definition of a periprosthetic Joint infection(PJI)of the knee and the hip?can the same criteriabe used for both joints?proceedings of international consensuson orthopedic infections[J].J Arthroplasty,2019,34(2S):S325-327.
[14]Huerfano E,Bautista M,Huerfano M,et al.Screening for infection before revisionhip arthroplasty:a Meta-analysis of likelihood ratios of erythrocyte sedimentation rate and serum C-reactive protein levels[J].J Am Acad Orthop Surg,2017,25(12):809-817.
[15]Bauer TW,Bedair H,Creech JD,et al.Hip and knee Section,diagnosis,laboratory tests:proceedings of international consensus on orthopedic infections[J].J Arthroplasty,2019,34(2s):S351-359.
[16]Shahi A,Kheir MM,Tarabichi M,et al.Serum D-Dimer test is promising for the diagnosis of periprosthetic joint infection and timing of reimplantation[J].J Bone Joint Surg Am,2017,99(17):1419-1427.
[17]Lee YS,Koo KH,Kim HJ,et al.Synovial fluid biomarkers for the diagnosis of periprosthetic joint infection:a systematic review and Metaanalysis[J].J Bone Joint Surg Am,2017,99(24):2077-2084.
[18]Parvizi J,Jacovides C,Antoci V,et al.Diagnosis of periprosthetic joint infection:the utility of a simple yet unappreciated enzyme[J].J Bone Joint Surg Am,2011,93(24):2242-2248.
[19]Wetters NG,Berend KR,Lombardi AV,et al.Leukocyte esterase reagent strips for the rapid diagnosis of periprosthetic joint infectio[J].J Arthroplasty,2012,27(8 Suppl):8-11.
[20]Deirmengian C,Kardos K,Kilmartin P,et al.The alpha-defensin test for periprosthetic joint infection outperforms the leukocyte esterase test strip[J].Clin Orthop Relat Res,2015,473(1):198-203.
[21]Aggarwal VK,Tischler E,Ghanem E,et al.Leukocyte esterase from synovial fluid aspirate:a technical note[J].J Arthroplasty,2013,28(1):193-195.
[22]Li R,Lu Q,Zhou YG,et al.Centrifugation may change the results of leukocyte esterase strip testing in the diagnosis of periprosthetic joint infection[J].J Arthroplasty,2018,33(9):2981-2985.
[23]Bahremand M,Schumacher HR Jr.Effect of medication on synovial fluid leukocyte differentials in patients with rheumatoid arthritis[J].Arthritis Rheum,1991,34(9):1173-1176.
[24]Deirmengian C,Kardos K,Kilmartin P,et al.The alpha-defensin test for periprosthetic joint infection responds to a wide spectrum of organisms[J].Clin Orthop Relat Res,2015,473(7):2229-2235.
[25]Shahi A,Parvizi J,Kazarian GS,et al.The alpha-defensin test for periprosthetic joint infections is not affected by prior antibiotic administration[J].Clin Orthop Relat Res,2016,474(7):1610-1615.
[26]Sigmund IK,Holinka J,Gamper J,et al.Qualitative alpha-defensin test(Synovasure)for the diagnosis of periprosthetic infection in revision total joint arthroplasty[J].Bone Joint J,2017,99-b(1):66-72.
[27]Ahmad SS,Hirschmann MT,Becker R,et al.A Meta-analysis of synovial biomarkers in periprosthetic joint infection:Synovasure is less effective than the ELISA-based alpha-defensin test[J].Knee Surg Sports Traumatol Arthrosc,2018,26(10):3039-3047.
[28]Schafer P,Fink B,Sandow D,et al.Prolonged bacterial culture to identify late periprosthetic joint infection:a promising strategy[J].Clin Infect Dis,2008,47(11):1403-1409.
[29]Larsen LH,Lange J,Xu Y,et al.Optimizing culture methods for diagnosis of prosthetic joint infections:a summary of modifications and improvements reported since 1995[J].J Med Microbiol,2012,61(Pt 3):309-316.
[30]Mikhael MM,Hanssen AD,Sierra RJ.Failure of metal-on-metal total hip arthroplasty mimicking hip infection.A report of two cases[J].J Bone Joint Surg Am,2009,91(2):443-446.
[31]Browne JA,Bechtold CD,Berry DJ,et al.Failed metal-on-metal hip arthroplasties:a spectrum of clinical presentations and operative findings[J].Clin Orthop Relat Res,2010,468(9):2313-2320.
[32]Alijanipour P,Adeli B,Hansen EN,et al.Intraoperative purulence is not reliable for diagnosing periprosthetic joint infection[J].J Arthroplasty,2015,30(8):1403-1406.
[33]Grammatopoulos G,Munemoto M,Inagaki Y,et al.The Diagnosis of Infection in Metal-on-Metal Hip Arthroplasties[J].J Arthroplasty,2016,31(11):2569-2573.
[34]Tsaras G,Maduka-Ezeh A,Inwards CY,et al.Utility of intraoperative frozen section histopathology in the diagnosis of periprosthetic joint infection:a systematic review and meta-analysis[J].J Bone Joint Surg Am,2012,94(18):1700-1711.
[35]Zhao X,Guo C,Zhao GS,et al.Ten versus five polymorphonuclear leukocytes as threshold in frozen section tests for periprosthetic infection:a meta-analysis[J].J Arthroplasty,2013,28(6):913-917.
[36]Bori G,McNally MA,Athanasou N.Histopathology in periprosthetic joint infection:when will the morphomolecular diagnosis be a reality[J]?Biomed Res Int,2018,2018:1412701.
[37]Bemer P,Leger J,Milin S,et al.Histopathological diagnosis of prosthetic joint infection:does a threshold of 23 neutrophils do better than classification of the periprosthetic membrane in a prospective multicenter study[J]?J Clin Microbiol,2018,56(9).
[38]Kashima TG,Inagaki Y,Grammatopoulos G,et al.Use of chloroacetate esterase staining for the histological diagnosis of prosthetic joint infection[J].Virchows Arch,2015,466(5):595-601.
[39]Abdel MP,Akgun D,Akin G,et al.Hip and knee section,diagnosis,pathogen isolation,culture:proceedings of international consensus on orthopedic infections[J].J Arthroplasty,2019,34(2s):S361-367.
[40]Trampuz A,Piper KE,Jacobson MJ,et al.Sonication of removed hip and knee prostheses for diagnosis of infection[J].New Eng J Med,2007,357(7):654-663.
[41]Li C,Renz N,Thies CO,et al.Meta-analysis of sonicate fluid in blood culture bottles for diagnosing periprosthetic joint infection[J].J Bone Jt Infect,2018,3(5):273-279.
[42]Abdel Karim M,Andrawis J,Bengoa F,et al.Hip and knee section,diagnosis,algorithm:proceedings of international consensus on orthopedic infections[J].J Arthroplasty,2019,34(2s):S339-350.
[43]Tarabichi M,Shohat N,Goswami K,et al.Diagnosis of periprosthetic joint infection:the potential of next-generation sequencing[J].J Bone Joint Surg Am,2018,100(2):147-154.
[44]Tarabichi M,Shohat N,Goswami K,et al.Can next generation sequencing play a role in detecting pathogens in synovial fluid[J]?Bone Joint J,2018,100-B(2):127-133.
[45]Street TL,Sanderson ND,Atkins BL,et al.Molecular diagnosis of orthopedic-device-related infection directly from sonication fluid by metagenomic sequencing[J].J Clin Microbiol,2017,55(8):2334-2347.
[46]Thoendel MJ,Jeraldo PR,Greenwood-Quaintance KE,et al.Identification of prosthetic joint infection pathogens using a shotgun metagenomics approach[J].Clin Infect Dis,2018,67(9):1333-1338.
[47]Ivy MI,Thoendel MJ,Jeraldo PR,et al.Direct detection and identification of prosthetic joint infection pathogens in synovial fluid by metagenomic shotgun sequencing[J].J Clin Microbiol,2018,56(9).
[48]Xie K,Dai K,Qu X,et al.Serum and synovial fluid interleukin-6 for the diagnosis of periprosthetic joint infection[J].Sci Rep,2017,7(1):1496.
[49]Klim SM,Amerstorfer F,Gruber G,et al.Fibrinogen-a practical and cost efficient biomarker for detecting periprosthetic joint infection[J].Sci Rep,2018,8(1):8802.
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