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Clinical Advances in the Diagnosis and Management of Joint Infections
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Clinical Advances in the Diagnosis and Management of Joint Infections

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (30 November 2023) | Viewed by 2096

Special Issue Editor

Dr. Jinwei Xie

E-Mail Website
Guest Editor
Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu 610000, China
Interests: thrombosis; blood transfusion; hemostasis; fibrinolysis; arthroplasty; senescence; aging; chondrocytes; knee osteoarthritis; macrophage; enhanced recovery after surgery

Special Issue Information

Dear Colleagues,

As the population ages, demands for arthroplasty are continuing to increase. As a main and devastating complication, periprosthetic joint infection (PJI) is a major burden for the healthcare system, and accurate diagnosis is the starting point for effective treatment. However, the diagnosis of PJI can be difficult, and current diagnostic tests suffer problems with accuracy and the interpretation of results. In recent years, many new tests and techniques have been proposed and applied in clinical practice, but there is no consensus on the place of many of these in diagnostic pathways. This Special Issue aims to introduce the advances of clinical tests or techniques in PJI diagnosis and management, including (but not limited to) the following topics:

  • New biomarkers in the diagnosis of PJI;
  • New molecular biology techniques in the diagnosis of PJI;
  • New imaging techniques in the diagnosis of PJI;
  • New diagnosis algorism based on available tests or techniques;
  • The role of machine learning or artificial intelligence in the diagnosis of PJI;
  • The role of biofilm in the diagnosis and management of PJI;
  • The advances and clinical results of stage I or II revision of PJI;
  • New target therapy for PJI.

Dr. Jinwei Xie
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • periprosthetic joint infection
  • diagnosis
  • treatment
  • biomarkers
  • molecular biology
  • target therapy

Published Papers (2 papers)

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Research

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9 pages, 518 KiB  
Article
Acidity Is an Excellent Marker of Infection in Hip and Knee Arthroplasty
by Tobiáš Judl, Stanislav Popelka, Elena Tomšík, Martin Hrubý, Matěj Daniel, Jaroslav Fojt, Pavel Melicherčík, Ivan Landor and David Jahoda
J. Clin. Med. 2024, 13(3), 688; https://doi.org/10.3390/jcm13030688 - 25 Jan 2024
Cited by 1 | Viewed by 835
Abstract
Background: The diagnosis of joint replacement infection is a difficult clinical challenge that often occurs when the implant cannot be salvaged. We hypothesize that the pH value of synovial fluid could be an important indicator of the inflammatory status of the joint. However, [...] Read more.
Background: The diagnosis of joint replacement infection is a difficult clinical challenge that often occurs when the implant cannot be salvaged. We hypothesize that the pH value of synovial fluid could be an important indicator of the inflammatory status of the joint. However, in the literature, there is a lack of data on the pH changes in hip and knee joint replacements and their relation to infection and implant failure. In this study, we aimed to measure the pH levels of synovial fluid in patients with hip and knee joint replacements. We also investigated the potential of pH measurement as a diagnostic tool for joint replacement infection. In this study, we recorded the pH values to be 7.55 and 7.46 in patients where Pseudomonas aeruginosa was identified as the cause of the prosthetic joint infection. We attribute this to the different environments created by this specific bacterium. In other cases where the pH was higher, chronic mitigated infections were diagnosed, caused by strains of Staphylococcus aureus, Streptococcus agalactiase, and coagulase negative staphylococcus. Materials and methods: In our cohort of 155 patients with implanted hip (THA; n = 85) or knee (TKA; n = 70) joint replacements, we conducted a prospective study with a pH measurement. Out of the whole cohort, 44 patients had confirmed joint replacement infection (28.4%) (44/155). In 111 patients, infection was ruled out (71.6%) (111/155). Joint replacement infection was classified according to the criteria of the Musculoskeletal Infection Society (MSIS) from 2018. Based on the measured values, we determined the cut-off level for the probability of ongoing inflammation. We also determined the sensitivity and specificity of the measurement. Results: The group of patients with infection (n = 44) had a significantly lower synovial fluid pH (pH = 6.98 ± 0.48) than the group of patients with no infection (n = 111, pH = 7.82 ± 0.29, p < 0.001). The corresponding median pH values were 7.08 for the patients with infection and 7.83 for the patients with no infection. When we determined the cut-off level of pH 7.4, the sensitivity level of infected replacements was 88.6%, and the specificity level of the measurement was 95.5%. The predictive value of a positive test was 88.6%, and the predictive value of a negative test was 95.5%. Conclusions: Our results confirm that it is appropriate to include a pH measurement in the diagnostic spectrum of hip and knee replacements. This diagnostic approach has the potential to provide continuous in vivo feedback, facilitated by specialized biosensors. The advantage of this method is the future incorporation of a pH-detecting sensor into intelligent knee and hip replacements that will assess pH levels over time. By integrating these biosensors into intelligent implants, the early detection of joint replacement infections could be achieved, enhancing proactive intervention strategies. Full article
(This article belongs to the Special Issue Clinical Advances in the Diagnosis and Management of Joint Infections)
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16 pages, 724 KiB  
Systematic Review
Total Ankle Replacement Infections: A Systematic Review of the Literature
by Renato Zunarelli, Michele Fiore, Gianluca Lonardo, Andrea Pace, Valentina Persiani, Massimiliano De Paolis and Andrea Sambri
J. Clin. Med. 2023, 12(24), 7711; https://doi.org/10.3390/jcm12247711 - 15 Dec 2023
Viewed by 859
Abstract
Periprosthetic infection (PJI) after TAR is a serious complication, often requiring further surgery, including revision arthroplasty, conversion to ankle arthrodesis, or even amputation. This systematic review aims to summarize the current evidence on the management of TAR PJI and provide a comprehensive overview [...] Read more.
Periprosthetic infection (PJI) after TAR is a serious complication, often requiring further surgery, including revision arthroplasty, conversion to ankle arthrodesis, or even amputation. This systematic review aims to summarize the current evidence on the management of TAR PJI and provide a comprehensive overview of this topic, especially from an epidemiologic point of view. Three different databases (PubMed, Scopus, and Web of Science) were searched for relevant articles, and further references were obtained by cross-referencing. Seventy-one studies met the inclusion criteria, reporting on cases of TAR PJI. A total of 298 PJIs were retrieved. The mean incidence of PJI was 3.8% (range 0.2–26.1%). Furthermore, 53 (17.8%) were acute PJIs, whereas most of them (156, 52.3%) were late PJIs. Most of the studies were heterogeneous regarding the treatment protocols used, with a two-stage approach performed in most of the cases (107, 35.9%). While the prevalence of ankle PJI remains low, it is potentially one of the most devastating complications of TAR. This review highlights the lack of strong literature regarding TAR infections, thus highlighting a need for multicentric studies with homogeneous data regarding the treatment of ankle PJI to better understand outcomes. Full article
(This article belongs to the Special Issue Clinical Advances in the Diagnosis and Management of Joint Infections)
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