Skip to main content
Top
Published in: European Orthopaedics and Traumatology 6/2011

Open Access 01-05-2011 | Original Article

Bone and joint infections in adults: a comprehensive classification proposal

Authors: Carlo Luca Romanò, Delia Romanò, Nicola Logoluso, Lorenzo Drago

Published in: European Orthopaedics and Traumatology | Issue 6/2011

Login to get access

Abstract

Introduction and methods

Ten currently available classifications were tested for their ability to describe a continuous cohort of 300 adult patients affected by bone and joint infections. Each classification only focused, on the average, on 1.3 ± 0.4 features of a single clinical condition (osteomyelitis, implant-related infections, or septic arthritis), being able to classify 34.8 ± 24.7% of the patients, while a comprehensive classification system could describe all the patients considered in the study.

Result and conclusion

A comprehensive classification system permits more accurate classification of bone and joint infections in adults than any single classification available and may serve for didactic, scientific, and clinical purposes.
Literature
1.
go back to reference Chassaignac E (1852) De l’osteomyelite. Bull Mem Soc Chir 431–436 Chassaignac E (1852) De l’osteomyelite. Bull Mem Soc Chir 431–436
2.
go back to reference Gristina AG, Costerton JW (1984) Bacterial adherence and the glycocalyx and their role in musculoskeletal infection. Orthop Clin North Am 15(3):517–535PubMed Gristina AG, Costerton JW (1984) Bacterial adherence and the glycocalyx and their role in musculoskeletal infection. Orthop Clin North Am 15(3):517–535PubMed
3.
go back to reference Gristina AG, Shibata Y, Giridhar G, Kreger A, Myrvik QN (1994) The glycocalyx, biofilm, microbes, and resistant infection. Semin Arthroplasty 5(4):160–170PubMed Gristina AG, Shibata Y, Giridhar G, Kreger A, Myrvik QN (1994) The glycocalyx, biofilm, microbes, and resistant infection. Semin Arthroplasty 5(4):160–170PubMed
4.
go back to reference Levine SE, Esterhai JL, Heppenstall RB, Calhoun J, Mader JT (1993) Diagnoses and staging. Osteomyelitis and prosthetic joint infections. Clin Orthop Relat Res 295:77–86PubMed Levine SE, Esterhai JL, Heppenstall RB, Calhoun J, Mader JT (1993) Diagnoses and staging. Osteomyelitis and prosthetic joint infections. Clin Orthop Relat Res 295:77–86PubMed
5.
go back to reference Calhoun JH, Manring MM, Shirtliff M (2009) Osteomyelitis of the long bones. Semin Plast Surg 23(2):59–72PubMedCrossRef Calhoun JH, Manring MM, Shirtliff M (2009) Osteomyelitis of the long bones. Semin Plast Surg 23(2):59–72PubMedCrossRef
6.
go back to reference Cierny G 3rd, Mader JT, Pennick JJ (2003) A clinical staging system for adult osteomyelitis. Clin Orthop 414:7–24PubMedCrossRef Cierny G 3rd, Mader JT, Pennick JJ (2003) A clinical staging system for adult osteomyelitis. Clin Orthop 414:7–24PubMedCrossRef
7.
go back to reference Mader JT, Shirtliff M, Calhoun JH (1997) Staging and staging application in osteomyelitis. Clin Infect Dis 25:1303–1309PubMedCrossRef Mader JT, Shirtliff M, Calhoun JH (1997) Staging and staging application in osteomyelitis. Clin Infect Dis 25:1303–1309PubMedCrossRef
8.
go back to reference Waldvogel FA, Medoff G, Swartz MN (1970) Osteomyelitis: a review of clinical features, therapeutic considerations and unusual aspects (first of three parts). N Engl J Med 282:198–206PubMedCrossRef Waldvogel FA, Medoff G, Swartz MN (1970) Osteomyelitis: a review of clinical features, therapeutic considerations and unusual aspects (first of three parts). N Engl J Med 282:198–206PubMedCrossRef
9.
go back to reference Cierny G 3rd, DiPasquale D (2002) Periprosthetic total joint infections. Staging, treatment, and outcomes. Clin Orthop Relat Res 403:23–28PubMedCrossRef Cierny G 3rd, DiPasquale D (2002) Periprosthetic total joint infections. Staging, treatment, and outcomes. Clin Orthop Relat Res 403:23–28PubMedCrossRef
10.
go back to reference McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M (2002) Periprosthetic total hip infection. Outcomes using a staging system. Clin Orthop Relat Res 403:8–15PubMedCrossRef McPherson EJ, Woodson C, Holtom P, Roidis N, Shufelt C, Patzakis M (2002) Periprosthetic total hip infection. Outcomes using a staging system. Clin Orthop Relat Res 403:8–15PubMedCrossRef
11.
go back to reference Der Gelenkinfekt GA (1985) Inf Arzt 6:35–43 Der Gelenkinfekt GA (1985) Inf Arzt 6:35–43
13.
go back to reference Tsukayama DT, Estrada R, Gustilo RB (1996) Infection after total hip arthroplasty. A study of one hundred and six infections. J Bone Joint Surg Am 78:512–523PubMed Tsukayama DT, Estrada R, Gustilo RB (1996) Infection after total hip arthroplasty. A study of one hundred and six infections. J Bone Joint Surg Am 78:512–523PubMed
14.
go back to reference Widmer AF (2001) New developments in diagnosis and treatment of infection in orthopedic implants. Clin Infect Dis 33:S94–S106PubMedCrossRef Widmer AF (2001) New developments in diagnosis and treatment of infection in orthopedic implants. Clin Infect Dis 33:S94–S106PubMedCrossRef
15.
go back to reference Zimmerli W (1999) Prosthetic device infections. In: Root RK, Waldvogel FA, Corey L, Stamm WE (eds) Clinical infectious diseases: a practical approach. Oxford University Press, Oxford, pp 801–808 Zimmerli W (1999) Prosthetic device infections. In: Root RK, Waldvogel FA, Corey L, Stamm WE (eds) Clinical infectious diseases: a practical approach. Oxford University Press, Oxford, pp 801–808
16.
go back to reference Carek PJ, Dickerson LM, Sack JL (2001) Diagnosis and management of osteomyelitis. Am Fam Physician 63(12):2413–2420PubMed Carek PJ, Dickerson LM, Sack JL (2001) Diagnosis and management of osteomyelitis. Am Fam Physician 63(12):2413–2420PubMed
17.
go back to reference Nelson JP (1977) Deep infection following total hip arthroplasty. J Bone Joint Surg Am 59:1042–1044PubMed Nelson JP (1977) Deep infection following total hip arthroplasty. J Bone Joint Surg Am 59:1042–1044PubMed
18.
go back to reference Schmalzried TP, Amstutz HC, Au MK, Dorey FJ (1992) Etiology of deep sepsis in total hip arthroplasty. The significance of hematogenous and recurrent infections. Clin Orthop Relat Res 280:200–207PubMed Schmalzried TP, Amstutz HC, Au MK, Dorey FJ (1992) Etiology of deep sepsis in total hip arthroplasty. The significance of hematogenous and recurrent infections. Clin Orthop Relat Res 280:200–207PubMed
19.
go back to reference Kelly PJ (1984) Infected nonunion of the femur and tibia. Orthop Clin North Am 15:481–490PubMed Kelly PJ (1984) Infected nonunion of the femur and tibia. Orthop Clin North Am 15:481–490PubMed
20.
go back to reference Berendt AR, Lipsky B (2004) Is this bone infected or not? Differentiating neuro-osteoarthropathy from osteomyelitis in the diabetic foot. Curr Diab Rep 4(6):424–429PubMedCrossRef Berendt AR, Lipsky B (2004) Is this bone infected or not? Differentiating neuro-osteoarthropathy from osteomyelitis in the diabetic foot. Curr Diab Rep 4(6):424–429PubMedCrossRef
21.
go back to reference Romanò C (2009) Infezioni osteo-articolari correlate all’impianto. Numero monografico de Lo Scalpello 23–3 Romanò C (2009) Infezioni osteo-articolari correlate all’impianto. Numero monografico de Lo Scalpello 23–3
22.
go back to reference Meani E, Romanò CL, Crosby L, Hofmann G (2007) Infection and local treatment in orthopaedic infections. Springer, HeidelbergCrossRef Meani E, Romanò CL, Crosby L, Hofmann G (2007) Infection and local treatment in orthopaedic infections. Springer, HeidelbergCrossRef
23.
go back to reference Gristina AG, Naylor P, Myrvik Q (1989) Infections from biomaterials and implants: a race for the surface. Med Prog Technol 14:205–224 Gristina AG, Naylor P, Myrvik Q (1989) Infections from biomaterials and implants: a race for the surface. Med Prog Technol 14:205–224
24.
go back to reference Romanò CL, Zavatarelli GA, Tinti M (2006) Meani E Profilassi dell’infezione nell’osteosintesi e classificazione “ICS” come guida al trattamento. Arch Ortop Reumatol 117(3):8–11 Romanò CL, Zavatarelli GA, Tinti M (2006) Meani E Profilassi dell’infezione nell’osteosintesi e classificazione “ICS” come guida al trattamento. Arch Ortop Reumatol 117(3):8–11
25.
go back to reference Court-Brown CM, Keating JF, McQueen MM (1992) Infection after intramedullary nailing of the tibia. Incidence and protocol for management. J Bone Joint Surg Br 74(5):770–774PubMed Court-Brown CM, Keating JF, McQueen MM (1992) Infection after intramedullary nailing of the tibia. Incidence and protocol for management. J Bone Joint Surg Br 74(5):770–774PubMed
26.
go back to reference Green SA, Larson MJ, Moore TJ (1987) Chronic sepsis following intramedullary nailing of femoral fractures. J Trauma 27(1):52–57PubMedCrossRef Green SA, Larson MJ, Moore TJ (1987) Chronic sepsis following intramedullary nailing of femoral fractures. J Trauma 27(1):52–57PubMedCrossRef
27.
go back to reference Laky R (1989) Results of treatment of infected osteosynthesis cases. Magy Traumatol Orthop 32(3):187–193 Laky R (1989) Results of treatment of infected osteosynthesis cases. Magy Traumatol Orthop 32(3):187–193
28.
go back to reference Romanò C, Logoluso N (2009) Low intensity pulsed ultrasound for the treatment of bone delayed union or nonunion: a review. Ultrasound Med Biol 35(4):529–536PubMedCrossRef Romanò C, Logoluso N (2009) Low intensity pulsed ultrasound for the treatment of bone delayed union or nonunion: a review. Ultrasound Med Biol 35(4):529–536PubMedCrossRef
29.
go back to reference Weiland AJ, Moore JR, Daniel RK (1984) The efficacy of free tissue transfer in the treatment of osteomyelitis. J Bone Joint Surg Am 66:181–193PubMed Weiland AJ, Moore JR, Daniel RK (1984) The efficacy of free tissue transfer in the treatment of osteomyelitis. J Bone Joint Surg Am 66:181–193PubMed
30.
go back to reference Cierny G, Mader JT, Penninck JJ (1985) A clinical staging for adult osteomyelitis. Cont Orthop 10:5 Cierny G, Mader JT, Penninck JJ (1985) A clinical staging for adult osteomyelitis. Cont Orthop 10:5
31.
go back to reference Anagnostakos K, Schmid NV, Kelm J, Grün U, Jung J (2009) Classification of hip joint infections. Int J Med Sci 6(5):227–233PubMed Anagnostakos K, Schmid NV, Kelm J, Grün U, Jung J (2009) Classification of hip joint infections. Int J Med Sci 6(5):227–233PubMed
32.
go back to reference Romanò CL, Logoluso N, Elia A, Romanò D (2010) Osteomyelitis in elderly patients. BMC Geriatr 10(Suppl 1):L15CrossRef Romanò CL, Logoluso N, Elia A, Romanò D (2010) Osteomyelitis in elderly patients. BMC Geriatr 10(Suppl 1):L15CrossRef
33.
go back to reference Cierny G, Mader JT (1984) Adult chronic osteomyelitis—an overview. Orthopedics 7(10):1557–1564 Cierny G, Mader JT (1984) Adult chronic osteomyelitis—an overview. Orthopedics 7(10):1557–1564
34.
go back to reference Ure KJ, Amstutz HC, Nasser S, Schmalzried TP (1998) Direct-exchange for the arthroplasty treatment of infection after total hip arthroplasty. J Bone Joint Surg Am 80:961–968PubMed Ure KJ, Amstutz HC, Nasser S, Schmalzried TP (1998) Direct-exchange for the arthroplasty treatment of infection after total hip arthroplasty. J Bone Joint Surg Am 80:961–968PubMed
35.
go back to reference Kilgus DJ, Howe DJ, Strang A (2002) Results of periprosthetic hip and knee infections caused by resistant bacteria. Clin Orthop Relat Res 404:116–124PubMedCrossRef Kilgus DJ, Howe DJ, Strang A (2002) Results of periprosthetic hip and knee infections caused by resistant bacteria. Clin Orthop Relat Res 404:116–124PubMedCrossRef
36.
go back to reference Lazzarini L, Manfrin V, De Lalla F (2004) Candidal prosthetic hip infection in a patient with previous candidal septic arthritis. J Arthroplasty 19:248–252PubMedCrossRef Lazzarini L, Manfrin V, De Lalla F (2004) Candidal prosthetic hip infection in a patient with previous candidal septic arthritis. J Arthroplasty 19:248–252PubMedCrossRef
37.
go back to reference Calhoun JH, Mader JT (1989) Antibiotic beads in the management of surgical infection. Am J Surg 157:443–449PubMedCrossRef Calhoun JH, Mader JT (1989) Antibiotic beads in the management of surgical infection. Am J Surg 157:443–449PubMedCrossRef
38.
go back to reference Anthony JP, Mathes SJ, Alpert BS (1991) The muscle flap in the treatment of chronic lower extremity osteo-myelitis: results in patients over 5 years after treatment. Plast Reconstr Surg 88:311–318PubMedCrossRef Anthony JP, Mathes SJ, Alpert BS (1991) The muscle flap in the treatment of chronic lower extremity osteo-myelitis: results in patients over 5 years after treatment. Plast Reconstr Surg 88:311–318PubMedCrossRef
39.
go back to reference Beris AE, Soucacos PN, Xenakis TA (1995) Latissimus dorsi free transfer for coverage of extensive soft tissue defects. Acta Orthop Scand 264:31–34 Beris AE, Soucacos PN, Xenakis TA (1995) Latissimus dorsi free transfer for coverage of extensive soft tissue defects. Acta Orthop Scand 264:31–34
40.
go back to reference Lazzarini L, Mader JT, Calhoun JH (2004) Osteomyelitis in long bones. J Bone Joint Surg Am 86:2305–2318PubMed Lazzarini L, Mader JT, Calhoun JH (2004) Osteomyelitis in long bones. J Bone Joint Surg Am 86:2305–2318PubMed
41.
go back to reference Papineau LJ, Alfageme A, Dalcourt JP (1979) Osteomyelite chronique: excision et greffe de spongieux a l’air libre apres mises a plat extensives. Int Orthop 3:165–176. 20PubMedCrossRef Papineau LJ, Alfageme A, Dalcourt JP (1979) Osteomyelite chronique: excision et greffe de spongieux a l’air libre apres mises a plat extensives. Int Orthop 3:165–176. 20PubMedCrossRef
42.
go back to reference D’Antonio JA, Capello WN, Borden LS, Bargar WL, Bierbaum BF, Boettcher WG, Steinberg ME, Stulberg SD, Wedge JH (1989) Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res 243:126–137PubMed D’Antonio JA, Capello WN, Borden LS, Bargar WL, Bierbaum BF, Boettcher WG, Steinberg ME, Stulberg SD, Wedge JH (1989) Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res 243:126–137PubMed
43.
go back to reference D’Antonio J, McCarthy JC, Bargar WL, Borden LS, Capello WN, Collis DK, Steinberg ME, Wedge JH (1993) Classification of femoral abnormalities in total hip arthroplasty. Clin Orthop Relat Res 296:133–139PubMed D’Antonio J, McCarthy JC, Bargar WL, Borden LS, Capello WN, Collis DK, Steinberg ME, Wedge JH (1993) Classification of femoral abnormalities in total hip arthroplasty. Clin Orthop Relat Res 296:133–139PubMed
44.
go back to reference Della Valle CJ, Paprosky WG (2003) Classification and an algorithmic approach to the reconstruction of femoral deficiency in revision total hip arthroplasty. J Bone Joint Surg Am 85(suppl 4):1–6 Della Valle CJ, Paprosky WG (2003) Classification and an algorithmic approach to the reconstruction of femoral deficiency in revision total hip arthroplasty. J Bone Joint Surg Am 85(suppl 4):1–6
45.
go back to reference Paprosky WG, Bradford MS, Younger TI (1994) Classification of bone defects in failed prostheses. Chir Organi Mov 79:285–291PubMed Paprosky WG, Bradford MS, Younger TI (1994) Classification of bone defects in failed prostheses. Chir Organi Mov 79:285–291PubMed
46.
go back to reference Gordon L, Chiu EJ (1988) Treatment of infected non-unions and segmental defects of the tibia with staged microvascular muscle transplantation and bone-grafting. J Bone Joint Surg Am 70:377–386PubMed Gordon L, Chiu EJ (1988) Treatment of infected non-unions and segmental defects of the tibia with staged microvascular muscle transplantation and bone-grafting. J Bone Joint Surg Am 70:377–386PubMed
47.
go back to reference Romanò CL, Meani E (2006) Il difetto osseo nelle infezioni: proposta di classificazione e opzioni di trattamento. Arch Ortop Reumatol 117:14–15 Romanò CL, Meani E (2006) Il difetto osseo nelle infezioni: proposta di classificazione e opzioni di trattamento. Arch Ortop Reumatol 117:14–15
48.
go back to reference Calhoun JH, Anger DM, Mader JT (1991) The Ilizarov technique in the treatment of osteomyelitis. Tex Med 87:56–59PubMed Calhoun JH, Anger DM, Mader JT (1991) The Ilizarov technique in the treatment of osteomyelitis. Tex Med 87:56–59PubMed
49.
go back to reference Ger R (1977) Muscle transposition for treatment and prevention of chronic traumatic osteomyelitis of the tibia. J Bone Joint Surg Am 59:784–791PubMed Ger R (1977) Muscle transposition for treatment and prevention of chronic traumatic osteomyelitis of the tibia. J Bone Joint Surg Am 59:784–791PubMed
Metadata
Title
Bone and joint infections in adults: a comprehensive classification proposal
Authors
Carlo Luca Romanò
Delia Romanò
Nicola Logoluso
Lorenzo Drago
Publication date
01-05-2011
Publisher
Springer-Verlag
Published in
European Orthopaedics and Traumatology / Issue 6/2011
Print ISSN: 1867-4569
Electronic ISSN: 1867-4577
DOI
https://doi.org/10.1007/s12570-011-0056-8

Other articles of this Issue 6/2011

European Orthopaedics and Traumatology 6/2011 Go to the issue

Editorial

Editorial