International consensus group holds meeting on periprosthetic joint infection

PHILADELPHIA — The International Consensus Group on Periprosthetic Joint Infection met yesterday to vote on consensus statements about the current state of knowledge, best practices and future studies in the diagnosis and management of periprosthetic joint infections.

“We need to congratulate ourselves in accomplishing what I think is an incredible, unique exercise that not only has not happened in orthopedics, it is extremely rare. I am not aware of many of these [meetings] taking place in any other medical specialties,” Javad Parvizi, MD, FRCS, said.

Javad Parvizi

Parvizi and Thorsten Gehrke, MD, began the process of creating an international consensus group on periprosthetic infection more than a year ago. The consensus process involved more than 400 participants, 300 of whom attended the meeting, here. The delegates represented 54 countries, 160 institutions and more than 100 societies.

“This is truly an international initiative, and we are grateful to all of you have traveled so far,” Parvizi, who is an Orthopedics Today Editorial Board member, said.

The Steering Committee of Parvizi, Gehrke and Daniel Kendoff, MD, identified 15 major themes of patient care for periprosthetic joint infections. For each theme, liaisons and both U.S. and international leaders were selected. The selection of the delegates was chosen based on expertise and productive activity in the field. Delegates were assigned by interest, balance and opportunity for great debate among the workgroups. The consensus group included orthopedic surgeons, infectious disease physicians, scientists and musculoskeletal pathologists and radiologists.

Thorsten Gehrke

“On some of the issues that you are addressing, the literature is not definitive, so we need good judgment. We need the reflection of a collective judgment, a community judgment. You are it,” William L. Cats-Baril, PhD, told the delegates during his introduction.

The liaisons compiled delegate-generated questions for each theme, and wrote state-of-the-knowledge position papers on each theme. Liaisons shared the first drafts with their workgroups by email and specially created website and discussion forums. Prior to the meeting, the consensus process involved more than 23,500 email exchanges. In addition, more than 3,500 literature sources were reviewed and cited in the consensus statements.

The leaders managed the discussion within each theme and distilled the feedback to their workgroups. After multiple drafts of the consensus statements, comments were integrated into a fourth draft, which the delegates debated the night prior to the meeting. All the delegates, leaders and liaisons voted on the fifth draft of the consensus statements at the meeting.

In total, the consensus group voted on 212 questions, with 90% of the consensus statements achieving more than 80% agreement. One consensus statement received 100% agreement, Cats-Beril said, while only four items had less than 66% consensus.

William L. Cats-Baril

All of the debated consensus statements that need additional discussion during the voting achieved more than 77% agreement after revision. Two statements will be reviewed again to understand why there was disagreement, Cats-Baril said.

“There was little that you disagreed with; a tremendous amount of work went into making your opinions converge,” Cats-Baril told the delegates.

The International Consensus on Periprosthetic Joint Infection plans to disseminate the approved consensus documents to the delegates for final review and comments within a few days, with final comments due by the end of August. Decisions for final publication and dissemination of the information are pending.

Reference:
The International Consensus Meeting on Periprosthetic Joint Infection. Aug. 1, 2013; Philadelphia.

Disclosures: Parvizi is a consultant to Zimmer, Smith & Nephew, 3M and Convatec. Cats-Baril and Gehrke have no relevant financial disclosures.