Consensus criteria may effectively identify PJI in revision shoulder arthroplasty
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Key takeaways:
- Patients in the unlikely infection group had the highest percentage of virulent organisms from culture.
- Two of the highest predictive values of infection were from aspirate.
Results presented at the Musculoskeletal Infection Society Annual Meeting showed the 2018 International Consensus Meeting criteria may effectively identify periprosthetic joint infection in revision shoulder arthroplasty.
Mark M. Cullen, MD, a PGY-4 at the Duke University School of Medicine, and colleagues retrospectively analyzed data from 385 revision shoulder arthroplasties performed between July 2013 and January 2024 to determine whether the 2018 International Consensus Meeting (ICM) criteria could identify PJI. Cullen said they categorized patients into definitive, probable, possible or unlikely infection groups based on 2018 ICM criteria.
“Looking at major criteria, we had 38 patients that had definitive PJI,” Cullen said. “Sevenity-one percent of them had one major criteria, with the majority of those being intra-articular purulence; about 25% were diagnosed with two or three [criteria]; and only about 5% had all three of these criteria.”
For minor criteria, Cullen said patients in the definitive infection group had elevated C-reactive protein and erythrocyte sedimentation rate (ESR), an increased percentage of successful preoperative aspirates and an increased number of virulent organisms.
“But it is interesting to note that [the definitive group] had the lowest number of virulent organisms, whereas the unlikely group had the highest percentage of virulent organisms from culture,” he said.
Patients in the unlikely group also had no positive cultures in successful aspirate prior to surgery as well as no increased synovial polymorphonuclear neutrophils (PMNs), according to Cullen.
He said the highest positive predictive values of PJI included elevated ESR, synovial white blood cell count and synovial PMN percentage, while the highest negative predictive values included not having elevated CRP, not having wound drainage and not having decreased platelet counts.
“Aspirate in shoulder arthroplasty is a little bit of a controversial topic because it has these low virulent organisms, sometimes single culture, that are a little bit difficult to interpret and see how we are going to manage it. But it does have value,” Cullen said. “Our two highest positive predictive values were from aspirate, and, looking at our data, only 4% were successful in the unlikely group, but I think it is an area where we could increase the number of aspirates that we attempt.”
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Cullen MM, et al. Paper 1308. Presented at: Musculoskeletal Infection Society Annual Meeting; Aug. 2-3, 2024; Durham, North Carolina (hybrid meeting).
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