Implications for diagnosis and treatment of peri-spinal implant infections from experiences in periprosthetic joint infections-a literature comparison and review

Daniel Karczewski; Matthias Pumberger; Michael Müller; Octavian Andronic; Carsten Perka; Tobias Winkler

doi:10.21037/jss-20-12

Implications for diagnosis and treatment of peri-spinal implant infections from experiences in periprosthetic joint infections-a literature comparison and review

J Spine Surg. 2020 Dec;6(4):800-813. doi: 10.21037/jss-20-12.

Authors

Daniel Karczewski^{1

2}, Matthias Pumberger¹, Michael Müller¹, Octavian Andronic², Carsten Perka¹, Tobias Winkler^{1

3

4}

Affiliations

¹ Center for Musculoskeletal Surgery, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
² Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
³ Julius Wolff Institute, Charité - Universit tsmedizin Berlin, Berlin, Germany.
⁴ Berlin Institute of Health Center for Regenerative Therapies, Charité - Universit tsmedizin Berlin, Berlin, Germany.

Abstract

Both, periprosthetic joint infection (PJI) and peri-spinal implant infection (PSII) are serious complications occurring in arthroplasty and spine instrumentation with absolute numbers expected to rise in the next years. The currently existing literature data describing the characteristics of PSII are limited when compared to PJI studies. However, both PJI and PSII exhibit similarities concerning pathogenesis, symptoms, diagnosis, treatment and prognosis. This literature review aims at comparing PJI and PSII and to develop implications for diagnosis and treatment of PSII from existing studies about PJI. The review was performed on the basis of a structured PubMed, Cochrane Library, and Medline analysis and existing guidelines, with 99 references being included. The results indicate that specific terms like re-infection should be defined in the context of PSII based on existing definitions of PJI, that in vitro biofilm studies and studies analyzing different prosthesis surfaces in arthroplasty could be used for PSII, and that histopathology as an additional standard tool in PSII diagnosis might be helpful. In addition, the development of a standardized algorithm-based treatment system with antibiotic protocols, including long term suppression, for PSII similar to the ones existing for PJI is necessary.

Keywords: Periprosthetic joint infection (PJI); arthroplasty infection; comparison; peri-spinal implant infection (PSII); spine infection.

Publication types

Review