Top

Published in:

01-01-2018 | Original Paper

The Kidney, Liver, Index surgery and C reactive protein score is a predictor of treatment response in acute prosthetic joint infection

Authors: C Jiménez-Garrido, J M Gómez-Palomo, I Rodriguez-Delourme, F J Durán-Garrido, E Nuño-Álvarez, E Montañez-Heredia

Published in: International Orthopaedics | Issue 1/2018

Abstract

Purpose

This work seeks to verify the utility of the KLIC score as a predictor of treatment success or failure in patients with knee and hip acute prosthetic joint infections (APJI). These patients were treated in our centre, which is not a prosthetic joint infection reference centre. The KLIC score assesses factors such as chronic kidney failure (2 points) (Kidney), liver disease (1.5 points) (Liver), revision surgery or femoral neck fracture (1.5 points)and cemented prosthesis (2 points) (Index surgery) and a C-reactive protein level (CRP) greater than 11.5 mg/dL (2.5 points), as a predictor of treatment success or failure in patients with knee and hip acute prosthetic joint infections (APJI).

Methods

We retrospectively reviewed 30 patients with APJI who were treated using debridement, antibiotics, irrigation and retention (DAIR) treatment between January 2007 and December 2016. Patients’ KLIC scores were calculated. The main outcome was success or failure of DAIR treatment of APJI.

Results

DAIR treatment succeeded in 21 cases and failed in nine cases. Differences in outcome were found according to the KLIC score. For KLIC scores >2 and ≤4, there were three successes and zero failures; for scores 4–5, there were nine successes and two failures; for scores >5 and ≤7,there were nine successes and four failures; and for scores >7, there were zero successes and three failures (p = 0.025). We found a positive predictive value and negative predictive value of 33% and 100% for scores ≤4 (score for calculations: 3.5), 43% and 84% for scores 4–5 (4.5), 50% and 68% for scores >5 and ≤7 (5.5), and 100% and 76% for scores >7 (7.5), respectively. The area under the ROC curve was 0.762 (95% confidence interval, 0.569–0.955).

Conclusions

The KLIC score was useful in predicting success or failure of DAIR treatment of APJI. This supports the conclusion that with a score < 3.5, treatment is likely to succeed and with a score of >6, it is likely to fail.

Zmistowski B, Karam JA, Durinka JB, Casper DS, Parvizi J (2013) Periprosthetic joint infection increases the risk of one-year mortality. J Bone Joint Surg Am 95(24):2177–2184. https://doi.org/10.2106/JBJS.L.00789 CrossRefPubMed

Triantafyllopoulos GK, Soranoglou V, Memtsoudis SG, Poultsides LA (2016) Implant retention after acute and hematogenous periprosthetic hip and knee infections: whom, when and how? World J Orthop 7(9):546–552. https://doi.org/10.5312/wjo.v7.i9.546 CrossRefPubMedPubMedCentral

Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM et al (2012) Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 56:e1–25. https://doi.org/10.1093/cid/cis803 CrossRefPubMed

Marculescu CE, Berbari EF, Hanssen AD, Steckelberg JM, Harmsen SW, Mandrekar JN et al (2006) Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis 42:471–478. https://doi.org/10.1086/499234 CrossRefPubMed

Qasim SN, Swann A, Ashford R (2017) The DAIR (debridement, antibiotics and implant retention) procedure for infected total knee replacement—a literature review. SICOT J 3:2. https://doi.org/10.1051/sicotj/2016038 CrossRefPubMedPubMedCentral

Koyonos L, Zmistowski B, Valle Della CJ, Parvizi J (2011) Infection control rate of irrigation and debridement for periprosthetic joint infection. Clin Orthop Relat Res 469:3043–3048. https://doi.org/10.1007/s11999-011-1910-2 CrossRefPubMedPubMedCentral

Buller LT, Sabry FY, Easton RW, Klika AK, Barsoum WK (2012) The preoperative prediction of success following irrigation and debridement with polyethylene exchange for hip and knee prosthetic joint infections. J Arthroplast 27(6):857–864.e1-4. https://doi.org/10.1016/j.arth.2012.01.003 CrossRef

Choi HR, von Knoch F, Kandil AO, Zurakowski D, Moore S, Malchau H (2012) Retention treatment after periprosthetic total hip arthroplasty infection. Int Orthop 36(4):723–729. https://doi.org/10.1007/s00264-011-1324-5 CrossRefPubMed

Marczak D, Synder M, Sibiński M, Polguj M, Dudka J, Kowalczewski J (2017) Two stage revision hip arthroplasty in periprosthetic joint infection. Comparison study: with or without the use of a spacer. Int Orthop 2017:18. https://doi.org/10.1007/s00264-017-3500-8

10.

Sherrell JC, Fehring TK, Odum S et al (2011) The Chitranjan Ranawat award: fate of two-stage reimplantation after failed irrigation and debridement for periprosthetic knee infection. Clin Orthop Relat Res 469:18–25. https://doi.org/10.1007/s11999-010-1434-1 CrossRefPubMed

11.

Gardner J, Gioe TJ, Tatman P (2011) Can this prosthesis be saved?: implant salvage attempts in infected primary TKA. Clin Orthop Relat Res 469(4):970–976. https://doi.org/10.1007/s11999-010-1417-2 CrossRefPubMed

12.

Tornero E, Morata L, Martínez-Pastor JC, Bori G, Climent C, García-Velez DM, García-Ramiro S, Bosch J, Mensa J, Soriano A (2015) KLIC- score for predicting early failure in prosthetic joint infections treated with debridement, implant retention and antibiotics. Clin Microbiol Infect 21(8):786e9–e17. https://doi.org/10.1016/j.cmi.2015.04.012

13.

Tsukuyama DT, Estrada R, Gustilo RB (1996) Infection after total hip arthroplasty: a study of the treatment of one hundred and six infections. J Bone Joint Surg 78:512–523CrossRef

14.

Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Valle Della CJ et al (2011) New definition for periprosthetic joint infection: from the workgroup of the musculoskeletal infection society. Clin Orthop Relat Res 469:2992–2994. https://doi.org/10.1007/s11999-011-2102-9 CrossRefPubMedPubMedCentral

15.

Parvizi J, Gherke T (2014) International consensus group on periprosthetic joint infection: definition of periprosthetic joint infection. J Arthroplast 29(7):1331. https://doi.org/10.1016/j.arth.2014.03.009. CrossRef

16.

Moriarty TF, Kuehl R, Coenye T, Metsemakers WJ, Morgenstern M, Schwarz EM, Riool M, Zaat SAJ, Khana N, Kates SL, Richards RG (2017) Orthopaedic device-related infection: current and future interventions for improved prevention and treatment. EFORT Open Rev 1(4):89–99. https://doi.org/10.1302/2058-5241.1.000037 CrossRefPubMed

17.

Panteli M, Giannoudis PV (2017) Chronic osteomyelitis: what the surgeon needs to know. EFORT Open Rev Mar 13(1(5)):128–135. https://doi.org/10.1302/2058-5241.1.000017

18.

González-Vélez AE, Romero-Martín M, Villanueva-Orbaiz R, Díaz-Agero-Pérez C, Robustillo-Rodela A, Monge-Jodra V (2016) The cost of infection in hip arthroplasty: a matched case-control study. Rev Esp Cir Ortop Traumatol 60:227–233. https://doi.org/10.1016/j.recot.2016.02.001 PubMed

19.

Helwig P, Morlock J, Oberst M, Hauschild O, Hübner J, Borde J, Südkamp NP, Konstantinidis L (2014) Periprosthetic joint infection—effect on quality of life. Int Orthop 38(5):1077–1081. https://doi.org/10.1007/s00264-013-2265-y CrossRefPubMedPubMedCentral

Title: The Kidney, Liver, Index surgery and C reactive protein score is a predictor of treatment response in acute prosthetic joint infection
Authors: C Jiménez-Garrido
J M Gómez-Palomo
I Rodriguez-Delourme
F J Durán-Garrido
E Nuño-Álvarez
E Montañez-Heredia
Publication date: 01-01-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 1/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3670-4

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

The Kidney, Liver, Index surgery and C reactive protein score is a predictor of treatment response in acute prosthetic joint infection

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

Surgery for greater trochanteric pain syndrome after total hip replacement confers a poor outcome

Infection risk assessment in patients undergoing primary total knee arthroplasty

Effect of a collar on subsidence and local micromotion of cementless femoral stems: in vitro comparative study based on micro-computerised tomography

Correction to: A multi-center analysis of adverse events among two thousand, three hundred and seventy two adult patients undergoing adult autologous stem cell therapy for orthopaedic conditions

Septic arthritis associated with systemic sepsis

Reproducibility of a new method for measuring lowering and medialisation of the humerus after reverse shoulder arthroplasty