{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T05:03:26Z","timestamp":1772255006332,"version":"3.50.1"},"reference-count":17,"publisher":"Wiley","license":[{"start":{"date-parts":[[2018,6,21]],"date-time":"2018-06-21T00:00:00Z","timestamp":1529539200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Charit\u00e9-University Medicine Berlin"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BioMed Research International"],"published-print":{"date-parts":[[2018,6,21]]},"abstract":"<jats:p><jats:italic>Aim of This Study<\/jats:italic>. Periprosthetic joint infections (PJIs) require a special antimicrobial regimen, fundamentally different from an aseptic treatment, making a correct preoperative diagnosis essential. However, a successful preoperative microbe detection is not always possible. We wanted to find out<jats:bold> (1)<\/jats:bold> if a preoperative microbe detection is a prerequisite before starting a septic revision in suspected PJIs or if the preoperative diagnosis can solely be based on (para)clinical signs (persistent CRP &gt;1 mg\/dl, early X-ray loosening signs in the first 5 years, leucocytes joint aspiration &gt;1700\/<jats:italic>\u00b5<\/jats:italic>l, conspicuous history, and clinical signs like redness, pain, hyperthermia, swelling, and loss of function);<jats:bold> (2)<\/jats:bold> if patients with and without preoperative microbe detection have a different outcome; and<jats:bold> (3)<\/jats:bold> if the microbial growth is the most important criterion of a multifactorial PJI definition.<jats:italic> Methods<\/jats:italic>. We included all first-line two-stage hip (49) and knee (47) revisions, performed in our department from 06\/2013 on, with an available 2-year follow-up. A PJI was defined as one of the following four criteria: fistula or purulence, Krenn Morawietz type 2 or 3, joint aspirate &gt; 2000\/<jats:italic>\u03bc<\/jats:italic>l leukocytes or &gt;70% granulocytes, and microbial growth. This multifactorial PJI definition was based on the European Bone and Joint Infection Society (EBJIS). The standardized diagnostic algorithm is described in detail.<jats:italic> Results<\/jats:italic>.<jats:bold> (1) <\/jats:bold>24 hip and 16 knee cases were treated without preoperative microbe detection solely on the basis of a (para)clinical diagnosis (see above). In the hip 91.6% (22 of 24 cases) showed an intraoperative microbe detection. In the knee, in 68.7% (11 of 16 cases) a microbe was detected intraoperatively and in 93.7% (15 of 16) at least one secure PJI criterion could be confirmed intraoperatively.<jats:bold> (2) <\/jats:bold>No statistical significant (p .517) difference between patients with (n = 56, reinfection rate 8.9%) and without (n = 40, 15%) preoperative microbe detection was found in a 2-year follow-up.<jats:bold> (3) <\/jats:bold>Microbial growth remains the overall (pre- and intraoperatively) most important criterion (hip 95.9%; knee 89.3%), followed by Krenn Morawietz for the intraoperative diagnosis (hip 67.3%, knee 48.9%), and joint aspiration for the knee and fistula for the hip, respectively, as preoperative criteria.<jats:italic> Conclusion<\/jats:italic>. High rates of intraoperatively fulfilled EBJIS PJI criteria show that a preoperative microbe detection is not necessary before intervening in suspected PJIs. The indication for a septic revision can solely be based on (para)clinical signs. The new established diagnostic algorithm based on a multifactorial PJI definition showed high precision in finding PJIs.<\/jats:p>","DOI":"10.1155\/2018\/1729605","type":"journal-article","created":{"date-parts":[[2018,6,21]],"date-time":"2018-06-21T19:31:33Z","timestamp":1529609493000},"page":"1-7","source":"Crossref","is-referenced-by-count":16,"title":["The Preoperative Microbial Detection is No Prerequisite for the Indication of Septic Revision in Cases of Suspected Periprosthetic Joint Infection"],"prefix":"10.1155","volume":"2018","author":[{"given":"Daniel","family":"Karczewski","sequence":"first","affiliation":[{"name":"Center for Musculoskeletal Surgery, Department of Orthopaedic Surgery, Charit\u00e9-University Medicine, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Winkler","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery, Department of Orthopaedic Surgery, Charit\u00e9-University Medicine, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0993-581X","authenticated-orcid":true,"given":"Carsten","family":"Perka","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery, Department of Orthopaedic Surgery, Charit\u00e9-University Medicine, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8934-9676","authenticated-orcid":true,"given":"Michael","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Center for Musculoskeletal Surgery, Department of Orthopaedic Surgery, Charit\u00e9-University Medicine, Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00111-13"},{"issue":"7","key":"3","first-page":"822","volume":"33","year":"2004","journal-title":"Der Orthop\u00e4de"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.3109\/17453674.2014.966290"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1186\/1749-799X-3-31"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-013-2866-1"},{"key":"7","year":"2014"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis803"},{"key":"9","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620X.99B5.BJJ-2016-0851.R1"},{"key":"10","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-018-2886-0"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-011-2102-9"},{"key":"12","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-017-3430-5"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.1016\/j.prp.2014.09.017"},{"key":"14","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2012.02.022"},{"key":"15","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2009.11.004"},{"key":"16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiph.2015.12.001"},{"issue":"4","key":"17","first-page":"169","volume":"2","year":"2014","journal-title":"Joints"},{"key":"18","doi-asserted-by":"publisher","DOI":"10.1186\/s40001-017-0245-1"}],"container-title":["BioMed Research International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/downloads.hindawi.com\/journals\/bmri\/2018\/1729605.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/bmri\/2018\/1729605.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/bmri\/2018\/1729605.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2018,6,21]],"date-time":"2018-06-21T19:31:42Z","timestamp":1529609502000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.hindawi.com\/journals\/bmri\/2018\/1729605\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,21]]},"references-count":17,"alternative-id":["1729605","1729605"],"URL":"https:\/\/doi.org\/10.1155\/2018\/1729605","relation":{},"ISSN":["2314-6133","2314-6141"],"issn-type":[{"value":"2314-6133","type":"print"},{"value":"2314-6141","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6,21]]}}}