CommentaryFrom OT Europe

Reflections on the second International Consensus Meeting on Musculoskeletal Infection

Per Kjaersgaard-Andersen, MD
Per Kjaersgaard-Andersen

The second International Consensus Meeting on Musculoskeletal Infection was held less than 2 weeks ago on July 25-27 in Philadelphia under the leadership of Javad Parvizi, MD, FRCS, of Philadelphia, and Thorsten Gehrke, MD, of Hamburg, Germany. It was attended by 540 experts in musculoskeletal infection who met to discuss and consider, using the Delphi consensus method, how musculoskeletal infections should be optimally treated in 2018. These considerations were based on the existing literature, evidence and knowledge in the profession.

About 2 years ago, more than 3,000 questions related to musculoskeletal infection were submitted by worldwide experts and evaluated by a team at Rothman Institute in Philadelphia. The questions were scored by several international experts, which led to the 800 questions that were determined to be most important and were discussed and subjected to consensus voting at the 3-day meeting.

Data, discussions, decisions

I am impressed with how well Parvizi and Gehrke and their teams managed to handle such an important and large volume of data and information during the 3 intense days of the meeting. Because nearly all key international experts in the specialty were present, attendees could have fruitful discussions and come to clear and important decisions about the musculoskeletal infection diagnostics, evaluation and treatment.

The meeting may be over, but the process is not yet complete. The next step is finalizing a document that includes the decisions and recommendations that came out of the consensus meeting, proofreading it for possible errors and then publishing it worldwide.

EFORT was represented at the meeting by three orthopaedic surgeons from its leadership. EFORT will do its best to support the publishing and promotion of the final documents through our website and other channels. Also, we have invited Parvizi — and he has agreed — to hold an honorary lecture on this topic at the next EFORT Congress in June 2019 in Lisbon, Portugal.

Javad Parvizi, MD, FRCS, and Per Kjaersgaard-Andersen, MD
Javad Parvizi, MD, FRCS, (left), pictured with EFORT president Per Kjaersgaard-Andersen, MD, is scheduled to give an honorary lecture on musculoskeletal infection at the 2019 EFORT Congress in Lisbon, Portugal.

Source: Kristine Houck, Orthopaedics Today Europe

Even though the details of the above process were well-structured, and organizers did a good job of guiding the consensus process, it is still possible the most important step in this process may be overlooked: having all orthopaedic surgeons worldwide read the final document. It is important that the final document is read and the recommendations that resulted from the consensus meeting are understood and implemented by orthopaedic surgeons in their daily practice. This final step will surely be the most critical hurdle. It not only requires the full attention of many national and international orthopaedic societies, but also may depend on possible regulatory changes in some countries.

Per Kjaersgaard-Andersen, MD, and Jan Verhaar, MD, PhD
Among the EFORT representatives at the International Consensus Meeting on Musculoskeletal Infection was Per Kjaersgaard-Andersen, MD, (left), EFORT president and Orthopaedics Today Europe Chief Medical Editor, and Jan Verhaar, MD, PhD, an EFORT past president.

Source: Kristine Houck, Orthopaedics Today Europe

Acute vs chronic infection

It would be unfair to emphasize one or more topics from the meeting because so many topics were debated and ultimately voted on. However, a single topic required a long and sensible discussion that finally led to abandoning the former division of prosthetic joint infections (PJI) into acute and chronic infections. Instead, a more dynamic view of infections was proposed that is based on factors related to the type of infection and the patient’s health. However, to reach consensus it was still decided that within 4 weeks of the index surgery, PJI should be treated aggressively to prevent it from becoming “chronic.”

Personally, the meeting was one of the greatest experiences in my long career as an orthopaedic surgeon. To be part of a large international expert group, to discuss musculoskeletal infections from early morning to late evening over 3 days and to observe how many, diverse attendees can develop itself into group that can obtain a clear consensus following, as well as in between, sensible and hard discussions.

We could take several other topics within the orthopaedic specialty and do the same.

Thank you to Drs. Parvizi and Gehrke for their outstanding work to make the second International Consensus Meeting on Musculoskeletal Infection happen.

Disclosure: Kjaersgaard-Andersen reports no relevant financial disclosures.

Per Kjaersgaard-Andersen, MD
Per Kjaersgaard-Andersen

The second International Consensus Meeting on Musculoskeletal Infection was held less than 2 weeks ago on July 25-27 in Philadelphia under the leadership of Javad Parvizi, MD, FRCS, of Philadelphia, and Thorsten Gehrke, MD, of Hamburg, Germany. It was attended by 540 experts in musculoskeletal infection who met to discuss and consider, using the Delphi consensus method, how musculoskeletal infections should be optimally treated in 2018. These considerations were based on the existing literature, evidence and knowledge in the profession.

About 2 years ago, more than 3,000 questions related to musculoskeletal infection were submitted by worldwide experts and evaluated by a team at Rothman Institute in Philadelphia. The questions were scored by several international experts, which led to the 800 questions that were determined to be most important and were discussed and subjected to consensus voting at the 3-day meeting.

Data, discussions, decisions

I am impressed with how well Parvizi and Gehrke and their teams managed to handle such an important and large volume of data and information during the 3 intense days of the meeting. Because nearly all key international experts in the specialty were present, attendees could have fruitful discussions and come to clear and important decisions about the musculoskeletal infection diagnostics, evaluation and treatment.

The meeting may be over, but the process is not yet complete. The next step is finalizing a document that includes the decisions and recommendations that came out of the consensus meeting, proofreading it for possible errors and then publishing it worldwide.

EFORT was represented at the meeting by three orthopaedic surgeons from its leadership. EFORT will do its best to support the publishing and promotion of the final documents through our website and other channels. Also, we have invited Parvizi — and he has agreed — to hold an honorary lecture on this topic at the next EFORT Congress in June 2019 in Lisbon, Portugal.

Javad Parvizi, MD, FRCS, and Per Kjaersgaard-Andersen, MD
Javad Parvizi, MD, FRCS, (left), pictured with EFORT president Per Kjaersgaard-Andersen, MD, is scheduled to give an honorary lecture on musculoskeletal infection at the 2019 EFORT Congress in Lisbon, Portugal.

Source: Kristine Houck, Orthopaedics Today Europe

Even though the details of the above process were well-structured, and organizers did a good job of guiding the consensus process, it is still possible the most important step in this process may be overlooked: having all orthopaedic surgeons worldwide read the final document. It is important that the final document is read and the recommendations that resulted from the consensus meeting are understood and implemented by orthopaedic surgeons in their daily practice. This final step will surely be the most critical hurdle. It not only requires the full attention of many national and international orthopaedic societies, but also may depend on possible regulatory changes in some countries.

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Per Kjaersgaard-Andersen, MD, and Jan Verhaar, MD, PhD
Among the EFORT representatives at the International Consensus Meeting on Musculoskeletal Infection was Per Kjaersgaard-Andersen, MD, (left), EFORT president and Orthopaedics Today Europe Chief Medical Editor, and Jan Verhaar, MD, PhD, an EFORT past president.

Source: Kristine Houck, Orthopaedics Today Europe

Acute vs chronic infection

It would be unfair to emphasize one or more topics from the meeting because so many topics were debated and ultimately voted on. However, a single topic required a long and sensible discussion that finally led to abandoning the former division of prosthetic joint infections (PJI) into acute and chronic infections. Instead, a more dynamic view of infections was proposed that is based on factors related to the type of infection and the patient’s health. However, to reach consensus it was still decided that within 4 weeks of the index surgery, PJI should be treated aggressively to prevent it from becoming “chronic.”

Personally, the meeting was one of the greatest experiences in my long career as an orthopaedic surgeon. To be part of a large international expert group, to discuss musculoskeletal infections from early morning to late evening over 3 days and to observe how many, diverse attendees can develop itself into group that can obtain a clear consensus following, as well as in between, sensible and hard discussions.

We could take several other topics within the orthopaedic specialty and do the same.

Thank you to Drs. Parvizi and Gehrke for their outstanding work to make the second International Consensus Meeting on Musculoskeletal Infection happen.

Disclosure: Kjaersgaard-Andersen reports no relevant financial disclosures.