CommentaryFrom OT Europe

More consensus needed on postoperative infection in orthopaedic surgery

Per Kjaersgaard-Andersen, MD
Per Kjaersgaard-Andersen

At the recent 18th Annual EFORT Congress in Vienna, the interest in sessions about postoperative infection, especially its treatment, was noticeable. It seems to be a key topic for many orthopaedic surgeons. Certainly, we have patients with postoperative infections and we want to do our best to initially prevent it from happening, which is next to doing our best to eradicate it.

When I was an orthopaedic trainee, infection was also an issue and it was treated by “all of us” at more institutions. In contrast, today several departments have succeeded in getting colleagues interested in the diagnosis and treatment of postoperative infections, particularly for perioperative joint infection (PJI). New diagnostic approaches are being developed, treatment strategies are being discussed and patients who are at increased risk of PJI are being better defined. However, whatever we do, the number of cases with a postoperative infection is still low. Since the causes are multifactorial, it has become difficult to run scientific studies to prove the efficacy of different treatment approaches.

This was one of the main reasons Javad Parvizi, MD, FRCS, and Thorsten Gehrke, MD, took the initiative to organize the first International Consensus Meeting on Periprosthetic Joint Infection on Orthopaedic Infections in Philadelphia in August 2013. The outcome of the consensus conference has been widely discussed and implemented worldwide, and the initiative is greatly appreciated. At EFORT, we decided to follow up on these consensus statements. For the 16th EFORT Annual Congress in 2015 in Prague, we selected infection as the main topic. The European Bone & Joint Infection Society assisted with the related congress sessions that year, which were met with considerable attention.

I wonder why there is so much interest in the topic of infection in orthopaedic surgery. One can only speculate, but when leaders within the orthopaedic field, like Parvizi and Gehrke, take the lead for an initiative, I think more colleagues feel their professional, long-term needs are being met for recognized approaches to manage patients with infection. Those who want to learn as much as possible about this subject are also motivated to become better educated in this area, which is an effort that will benefit patients and our society in general.

However, still several issues related to infections are not yet described in detail or have not received any consensus, which means there is still a lot of work to do in this area. Therefore, it is with great interest that I have learned that Parvizi and Gehrke will hold the second International Consensus Meeting on Periprosthetic Joint Infection on Orthopaedic Infections from July 26-28, 2018 in Philadelphia. This is much needed. A large international panel will be present for the meeting to analyze, answer and ultimately vote on several questions about PJI, such as why do more PJIs occur during the warmer summer months as reported in many national joint replacement registries. What is the explanation? Can anything be done to stop or reduce the problem? Perhaps orthopaedists can stop doing surgery when the outside temperature reaches a given level.

Above all, we need to evaluate the evidence behind this concept and others related to PJI. Hopefully, the consensus meeting will provide this information and more.

Disclosure: Kjaersgaard-Andersen reports no relevant financial disclosures.

Per Kjaersgaard-Andersen, MD
Per Kjaersgaard-Andersen

At the recent 18th Annual EFORT Congress in Vienna, the interest in sessions about postoperative infection, especially its treatment, was noticeable. It seems to be a key topic for many orthopaedic surgeons. Certainly, we have patients with postoperative infections and we want to do our best to initially prevent it from happening, which is next to doing our best to eradicate it.

When I was an orthopaedic trainee, infection was also an issue and it was treated by “all of us” at more institutions. In contrast, today several departments have succeeded in getting colleagues interested in the diagnosis and treatment of postoperative infections, particularly for perioperative joint infection (PJI). New diagnostic approaches are being developed, treatment strategies are being discussed and patients who are at increased risk of PJI are being better defined. However, whatever we do, the number of cases with a postoperative infection is still low. Since the causes are multifactorial, it has become difficult to run scientific studies to prove the efficacy of different treatment approaches.

This was one of the main reasons Javad Parvizi, MD, FRCS, and Thorsten Gehrke, MD, took the initiative to organize the first International Consensus Meeting on Periprosthetic Joint Infection on Orthopaedic Infections in Philadelphia in August 2013. The outcome of the consensus conference has been widely discussed and implemented worldwide, and the initiative is greatly appreciated. At EFORT, we decided to follow up on these consensus statements. For the 16th EFORT Annual Congress in 2015 in Prague, we selected infection as the main topic. The European Bone & Joint Infection Society assisted with the related congress sessions that year, which were met with considerable attention.

I wonder why there is so much interest in the topic of infection in orthopaedic surgery. One can only speculate, but when leaders within the orthopaedic field, like Parvizi and Gehrke, take the lead for an initiative, I think more colleagues feel their professional, long-term needs are being met for recognized approaches to manage patients with infection. Those who want to learn as much as possible about this subject are also motivated to become better educated in this area, which is an effort that will benefit patients and our society in general.

However, still several issues related to infections are not yet described in detail or have not received any consensus, which means there is still a lot of work to do in this area. Therefore, it is with great interest that I have learned that Parvizi and Gehrke will hold the second International Consensus Meeting on Periprosthetic Joint Infection on Orthopaedic Infections from July 26-28, 2018 in Philadelphia. This is much needed. A large international panel will be present for the meeting to analyze, answer and ultimately vote on several questions about PJI, such as why do more PJIs occur during the warmer summer months as reported in many national joint replacement registries. What is the explanation? Can anything be done to stop or reduce the problem? Perhaps orthopaedists can stop doing surgery when the outside temperature reaches a given level.

Above all, we need to evaluate the evidence behind this concept and others related to PJI. Hopefully, the consensus meeting will provide this information and more.

Disclosure: Kjaersgaard-Andersen reports no relevant financial disclosures.