Are patients being evaluated for periprosthetic joint infection prior to referral to a tertiary care center?
Background: Patients with a painful or failed total joint arthroplasties should be evaluated for periprosthetic joint infection (PJI). The purpose of this study is to determine if patients referred to a tertiary care center had been evaluated for PJI according to the American Academy of Orthopaedic...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2018-06-01
|
| Series: | Arthroplasty Today |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352344117301322 |
| _version_ | 1811313679010889728 |
|---|---|
| author | Matthew W. Tetreault, MD Kenneth A. Estrera, MD Erdan Kayupov, MD Caroline Brander, BA Craig J. Della Valle, MD |
| author_facet | Matthew W. Tetreault, MD Kenneth A. Estrera, MD Erdan Kayupov, MD Caroline Brander, BA Craig J. Della Valle, MD |
| author_sort | Matthew W. Tetreault, MD |
| collection | DOAJ |
| description | Background: Patients with a painful or failed total joint arthroplasties should be evaluated for periprosthetic joint infection (PJI). The purpose of this study is to determine if patients referred to a tertiary care center had been evaluated for PJI according to the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines.
Methods: One hundred thirteen patients with painful hip (43) or knee (70) arthroplasties were referred to a single provider by orthopaedic surgeons outside our practice between 2012 and 2014. We retrospectively evaluated the workup by referring physicians, including measurement of serum erythrocyte sedimentation rate and C-reactive protein, performance of a joint aspiration if these values were abnormal, and obtainment of synovial fluid white blood cell count, differential, and cultures.
Results: Sixty-two of 113 patients (55%) did not have a workup that followed AAOS guidelines. Serum erythrocyte sedimentation rate and C-reactive protein were ordered for 64 of the 113 patients (57%). Of 25 patients with elevated inflammatory markers warranting aspiration, 15 (60%) had an aspiration attempted, with synovial fluid white blood cell, differential, and cultures obtained in 9 of 12 (75%) aspirations that yielded fluid. Of the 62 patients with an incomplete infection workup, 11 (18%) had a bone scan, 6 (10%) a computed tomography scan, and 3 (5%) a magnetic resonance imaging. Twelve of the 113 patients (11%) were ultimately diagnosed with PJI, with 5 undiagnosed prior to referral.
Conclusions: The AAOS guidelines to evaluate for PJI are frequently not being followed. Improving awareness of these guidelines may avoid unnecessary and costly evaluations and delay in the diagnosis of PJI. |
| first_indexed | 2024-04-13T10:59:02Z |
| format | Article |
| id | doaj.art-972f2dbb7b05417da2ec7504a4ec158e |
| institution | Directory Open Access Journal |
| issn | 2352-3441 |
| language | English |
| last_indexed | 2024-04-13T10:59:02Z |
| publishDate | 2018-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Arthroplasty Today |
| spelling | doaj.art-972f2dbb7b05417da2ec7504a4ec158e2022-12-22T02:49:28ZengElsevierArthroplasty Today2352-34412018-06-014221622010.1016/j.artd.2017.10.001Are patients being evaluated for periprosthetic joint infection prior to referral to a tertiary care center?Matthew W. Tetreault, MD0Kenneth A. Estrera, MD1Erdan Kayupov, MD2Caroline Brander, BA3Craig J. Della Valle, MD4Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USADepartment of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USADepartment of Orthopaedic Surgery, University of Illinois Hospital & Health Sciences System, Chicago, IL, USARush Medical College, Chicago, IL, USADepartment of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USABackground: Patients with a painful or failed total joint arthroplasties should be evaluated for periprosthetic joint infection (PJI). The purpose of this study is to determine if patients referred to a tertiary care center had been evaluated for PJI according to the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines. Methods: One hundred thirteen patients with painful hip (43) or knee (70) arthroplasties were referred to a single provider by orthopaedic surgeons outside our practice between 2012 and 2014. We retrospectively evaluated the workup by referring physicians, including measurement of serum erythrocyte sedimentation rate and C-reactive protein, performance of a joint aspiration if these values were abnormal, and obtainment of synovial fluid white blood cell count, differential, and cultures. Results: Sixty-two of 113 patients (55%) did not have a workup that followed AAOS guidelines. Serum erythrocyte sedimentation rate and C-reactive protein were ordered for 64 of the 113 patients (57%). Of 25 patients with elevated inflammatory markers warranting aspiration, 15 (60%) had an aspiration attempted, with synovial fluid white blood cell, differential, and cultures obtained in 9 of 12 (75%) aspirations that yielded fluid. Of the 62 patients with an incomplete infection workup, 11 (18%) had a bone scan, 6 (10%) a computed tomography scan, and 3 (5%) a magnetic resonance imaging. Twelve of the 113 patients (11%) were ultimately diagnosed with PJI, with 5 undiagnosed prior to referral. Conclusions: The AAOS guidelines to evaluate for PJI are frequently not being followed. Improving awareness of these guidelines may avoid unnecessary and costly evaluations and delay in the diagnosis of PJI.http://www.sciencedirect.com/science/article/pii/S2352344117301322periprosthetic joint infectionarthroplasty infectioninfection workupdiagnosisclinical practice guidelines |
| spellingShingle | Matthew W. Tetreault, MD Kenneth A. Estrera, MD Erdan Kayupov, MD Caroline Brander, BA Craig J. Della Valle, MD Are patients being evaluated for periprosthetic joint infection prior to referral to a tertiary care center? Arthroplasty Today periprosthetic joint infection arthroplasty infection infection workup diagnosis clinical practice guidelines |
| title | Are patients being evaluated for periprosthetic joint infection prior to referral to a tertiary care center? |
| title_full | Are patients being evaluated for periprosthetic joint infection prior to referral to a tertiary care center? |
| title_fullStr | Are patients being evaluated for periprosthetic joint infection prior to referral to a tertiary care center? |
| title_full_unstemmed | Are patients being evaluated for periprosthetic joint infection prior to referral to a tertiary care center? |
| title_short | Are patients being evaluated for periprosthetic joint infection prior to referral to a tertiary care center? |
| title_sort | are patients being evaluated for periprosthetic joint infection prior to referral to a tertiary care center |
| topic | periprosthetic joint infection arthroplasty infection infection workup diagnosis clinical practice guidelines |
| url | http://www.sciencedirect.com/science/article/pii/S2352344117301322 |
| work_keys_str_mv | AT matthewwtetreaultmd arepatientsbeingevaluatedforperiprostheticjointinfectionpriortoreferraltoatertiarycarecenter AT kennethaestreramd arepatientsbeingevaluatedforperiprostheticjointinfectionpriortoreferraltoatertiarycarecenter AT erdankayupovmd arepatientsbeingevaluatedforperiprostheticjointinfectionpriortoreferraltoatertiarycarecenter AT carolinebranderba arepatientsbeingevaluatedforperiprostheticjointinfectionpriortoreferraltoatertiarycarecenter AT craigjdellavallemd arepatientsbeingevaluatedforperiprostheticjointinfectionpriortoreferraltoatertiarycarecenter |