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Media Contact: Kenneth Robinson (KRobinson@AAHKS.org)
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For Immediate Release
November 04, 2023

The Question of Are All MSIS Tests Useful to Diagnosing Periprosthetic Joint Infection Receives the Young Investigator’s Award


November 04, 2023 (Dallas, TX) – An award-winning study was presented at the 2023 AAHKS Annual Meeting questioning whether all MSIS tests are useful when diagnosing periprosthetic joint infection (PJI). Current data evaluating the clinical value and cost-effectiveness of advanced diagnostic tests for periprosthetic joint infection diagnosis, including alpha-defensin and synovial C-reactive protein (CRP), is conflicting. This study aimed to evaluate the adequacy of preoperative and intraoperative PJI workup without the utilization of these tests.  

This study received the AAHKS James A. Rand, MD, Young Investigator’s Award during the 2023 Annual Meeting. The award recognizes young investigators who demonstrate clinical excellence in knee-related research.

Lead author Jason Kreinces, BS and co-authors Ittai Shichman, MD, Mackenzie A. Roof, MD, MBA, Hayley Raymond, BS, Alana Prinos, BS, Itay Ashkenazi, MD, Ran Schwarzkopf, MD, MSc and Vinay K. Aggarwal, MD identified all patients who underwent revision THA or TKA for suspected PJI between 2018 and 2020 and had a minimum follow-up of two years. Perioperative data and lab results were collected, and cases were dichotomized based on whether they met the 2018 Musculoskeletal Infection Society (MSIS) criteria for PJI. In total, 204 rTKA and 158 rTHA cases suspected for PJI were reviewed.  

Researchers uncovered that nearly 100 percent of the cases were categorized as “infected” for meeting the 2018 MSIS criteria without utilization of alpha-defensin or synovial CRP.

Given the high rate of cases satisfying PJI criteria during preoperative workup using our available tests, the synovial alpha-defensin and synovial CRP tests may not be necessary in the routine diagnostic workup of PJI. So, it’s suggested that the primary PJI workup process should be based on a stepwise algorithmic approach with the most economical testing necessary to determine a diagnosis first.

“The most important thing is to remember that clinical suspicion of infection should guide the workup. Ideally, when possible, an algorithmic approach to the workup is recommended and we found in our paper that using the ESR, CRP, synovial WBC, PMN and cultures are sufficient to diagnose PJI in more than 96% of cases,“ said Vinay K. Aggarwal, MD

Abstract: AAHKS James A. Rand, MD, Young Investigator’s Award Abstract 

About the American Association of Hip and Knee Surgeons

Established in 1991, the mission of AAHKS is to advance hip and knee patient care through education, advocacy, research and outreach. AAHKS has a membership of over 5,000 surgeons and other hip and knee health care professionals.

Kenneth Robinson, Communications Manager

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