Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Systematic Reviews
Published in: Systematic Reviews 1/2015

Open Access 01-12-2015 | Protocol

A protocol for a systematic review of the diagnostic accuracy of blood markers, synovial fluid, and tissue testing in periprosthetic joint infections (PJI)

Authors: Paul E. Beaule, Beverley Shea, Hesham Abedlbary, Nadera Ahmadzai, Becky Skidmore, Ranjeeta Mallick, Brian Hutton, Alexandra C. Bunting, Julian Moran, Roxanne Ward, David Moher

Published in: Systematic Reviews | Issue 1/2015

Login to get access

Abstract

Background

Total joint replacement (TJR) procedures have been one of the most rewarding interventions for treating patients suffering from joint disease. However, developing a periprosthetic joint infection (PJI) is a serious complication that is associated with the highest burden of cost and reduction in patients’ quality of life compared to other complications following TJRs. One of the main challenges facing clinicians who are treating PJIs is accurately diagnosing infection in a timely fashion. Multiple orthopedic associations have published clinical guidelines for diagnosing PJI which are based solely on consensus approaches, expert opinions, and narrative reviews. We believe that a higher quality of scientific rigor is necessary to establish a diagnostic guideline that represents current evidence more accurately and that identifies important knowledge gaps in PJI diagnosis. Therefore, we will conduct a systematic review on diagnostic performance of blood markers, synovial fluids, and tissue tests for diagnosing PJI.

Methods/design

Electronic search strategies will be developed and tested by an experienced medical information specialist in consultation with the review team, and gray literature will be searched using the checklist from CADTH’s Grey Matters Light. Two reviewers will independently screen the literature for inclusion using the prespecified eligibility criteria. Non-English language and animal-only studies will be excluded. Quality assessment and data extractions by reviewers will be verified, and disagreements will be resolved through consensus or third party adjudication. We will assess the quality of individual studies using the QUADAS-2 tool and use GRADE to summarize the strength of body of evidence. Analyses of evidence will be conducted in accordance with the Cochrane Handbook for Diagnostic Test Accuracy Reviews.

Discussion

We will conduct a systemic review of tests (blood markers, synovial fluids, and tissue testing) for diagnosing PJI in patients’ knee, hip, and shoulder joint replacements. This will be the first scientifically rigorous and comprehensive systematic review in the field and may feed into an evidence-based clinical practice guideline. We will compare the findings of this review with the consensus-based guides and discuss the differences, similarities, and knowledge gaps.

Systematic review registration

PROSPERO CRD42015023768
Appendix
Available only for authorised users
Literature
1.
Shearer DW, Youm J, Bozic KJ. Short-term complications have more effect on cost-effectiveness of THA than implant longevity. Clin Orthop Relat Res. 2015;473:1702–8.CrossRefPubMedPubMedCentral
2.
Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ, et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res. 2011;469:2992–4.CrossRefPubMedPubMedCentral
3.
Segawa H, Tsukayama DT, Kyle RF, Becker DA, Gustilo RB. Infection after total knee arthroplasty. A retrospective study of the treatment of eighty-one infections. J Bone Joint Surg Am. 1999;81:1434–45.PubMed
4.
Cats-Baril W, Gehrke T, Huff K, Kendoff D, Maltenfort M, Parvizi J. International consensus on periprosthetic joint infection: description of the consensus process. Clin Orthop Relat Res. 2013;471:4065–75.CrossRefPubMedPubMedCentral
5.
6.
Matar WY, Jafari SM, Restrepo C, Austin M, Purtill JJ, Parvizi J. Preventing infection in total joint arthroplasty. J Bone Joint Surg Am. 2010;92 Suppl 2:36–46.CrossRefPubMed
7.
Bozic KJ. The role of the payment system in improving value in healthcare. J Arthroplasty. 2015;30:341–2.CrossRefPubMed
8.
Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 2012;27:61–5.CrossRefPubMed
9.
10.
George DA, Gant V, Haddad FS. The management of periprosthetic infections in the future: a review of new forms of treatment. Bone Joint J. 2015;97-B:1162–9.CrossRefPubMed
11.
Saltzman MD, Marecek GS, Edwards SL, Kalainov DM. Infection after shoulder surgery. J Am Acad Orthop Surg. 2011;19:208–18.CrossRefPubMed
12.
13.
Topolski MS, Chin PY, Sperling JW, Cofield RH. Revision shoulder arthroplasty with positive intraoperative cultures: the value of preoperative studies and intraoperative histology. J Shoulder Elbow Surg. 2006;15:402–6.CrossRefPubMed
14.
Berbari E, Mabry T, Tsaras G, Spangehl M, Erwin PJ, Murad MH, et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am. 2010;92:2102–9.CrossRefPubMed
15.
Font-Vizcarra L, Garcia S, Martinez-Pastor JC, Sierra JM, Soriano A. Blood culture flasks for culturing synovial fluid in prosthetic joint infections. Clin Orthop Relat Res. 2010;468:2238–43.CrossRefPubMedPubMedCentral
16.
Fink B, Gebhard A, Fuerst M, Berger I, Schafer P. High diagnostic value of synovial biopsy in periprosthetic joint infection of the hip. Clin Orthop Relat Res. 2013;471:956–64.CrossRefPubMed
17.
Fink B, Makowiak C, Fuerst M, Berger I, Schafer P, Frommelt L. The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements. J Bone Joint Surg (Br). 2008;90:874–8.CrossRef
18.
Tsaras G, Maduka-Ezeh A, Inwards CY, Mabry T, Erwin PJ, Murad MH, et al. Utility of intraoperative frozen section histopathology in the diagnosis of periprosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am. 2012;94:1700–11.CrossRefPubMed
19.
Gallo J, Kolar M, Dendis M, Loveckova Y, Sauer P, Zapletalova J, et al. Culture and PCR analysis of joint fluid in the diagnosis of prosthetic joint infection. New Microbiol. 2008;31:97–104.PubMed
20.
Gallo J, Raska M, Dendis M, Florschutz AV, Kolar M. Molecular diagnosis of prosthetic joint infection. A review of evidence. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2004;148:123–9.CrossRefPubMed
21.
Parvizi J, Huang R, Raphael IJ, Maltenfort MG, Arnold WV, Rothman RH. Timing of symptomatic pulmonary embolism with warfarin following arthroplasty. J Arthroplasty. 2015;30:1050–3.CrossRefPubMed
22.
Gehrke T, Kendoff D. Peri-prosthetic hip infections: in favour of one-stage. Hip Int. 2012;22 Suppl 8:S40–5.CrossRefPubMed
23.
24.
Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62:1006–12.CrossRefPubMed
25.
Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;349:g7647.CrossRefPubMed
26.
Booth A, Clarke M, Dooley G, Ghersi D, Moher D, Petticrew M, et al. The nuts and bolts of PROSPERO: an international prospective register of systematic reviews. Syst Rev. 2012;1:2.CrossRefPubMedPubMedCentral
27.
Sampson M, McGowan J, Cogo E, Grimshaw J, Moher D, Lefebvre C. An evidence-based practice guideline for the peer review of electronic search strategies. J Clin Epidemiol. 2009;62:944–52.CrossRefPubMed
28.
29.
30.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–6.CrossRefPubMedPubMedCentral
31.
32.
Schunemann HJ, Oxman AD, Brozek J, Glasziou P, Jaeschke R, Vist GE, et al. Grading quality of evidence and strength of recommendations for diagnostic tests and strategies. BMJ. 2008;336:1106–10.CrossRefPubMedPubMedCentral
33.
Singh S, Chang SM, Matchar DB, Bass EB. Chapter 7: grading a body of evidence on diagnostic tests. J Gen Intern Med. 2012;27 Suppl 1:S47–55.CrossRefPubMed
34.
Reitsma JB, Glas AS, Rutjes AW, Scholten RJ, Bossuyt PM, Zwinderman AH. Bivariate analysis of sensitivity and specificity produces informative summary measures in diagnostic reviews. J Clin Epidemiol. 2005;58:982–90.CrossRefPubMed
35.
Rutter CM, Gatsonis CA. A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations. Stat Med. 2001;20:2865–84.CrossRefPubMed
36.
37.
Lijmer JG, Mol BW, Heisterkamp S, Bonsel GJ, Prins MH, van der Meulen JH, et al. Empirical evidence of design-related bias in studies of diagnostic tests. JAMA. 1999;282:1061–6.CrossRefPubMed
38.
Deeks J. Systematic reviews of evaluations of diagnostic and screening tests. In: Egger M, Smith G, Altman D, editors. Systematic reviews in health care: meta-analysis in context. 2nd ed. London: BMJ Books; 2001. p. 248–82.CrossRef
39.
Metadata
Title
A protocol for a systematic review of the diagnostic accuracy of blood markers, synovial fluid, and tissue testing in periprosthetic joint infections (PJI)
Authors
Paul E. Beaule
Beverley Shea
Hesham Abedlbary
Nadera Ahmadzai
Becky Skidmore
Ranjeeta Mallick
Brian Hutton
Alexandra C. Bunting
Julian Moran
Roxanne Ward
David Moher
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Systematic Reviews / Issue 1/2015
Electronic ISSN: 2046-4053
DOI
https://doi.org/10.1186/s13643-015-0124-1

Other articles of this Issue 1/2015

Systematic Reviews 1/2015 Go to the issue

Protocol

Outcomes in the offspring of mothers with pre-diabetes during pregnancy: a protocol for a systematic review

Protocol

Depth of anaesthesia monitoring during procedural sedation and analgesia: a systematic review protocol

Protocol

Pre-clinical evaluation of therapies to prevent or treat bone non-union: a systematic review protocol

Protocol

Resting blood pressure reductions following isometric handgrip exercise training and the impact of age and sex: protocol for a systematic review

Research

Managing the incidence of selective reporting bias: a survey of Cochrane review groups

Protocol

Identifying the content of home-based health behaviour change interventions for frail older people: a systematic review protocol