Prosthetic joint infections: is guideline-consistent surgical treatment beneficial?
Why this work is in the frame
A frame that forgets how it found something cannot be audited. These are the routes that admitted this work.
Bibliographic record
Abstract
Background: The diagnosis and treatment of prosthetic joint infection (PJI) remains challenging. In 2013, both the Infectious Diseases Society of America (IDSA) guidelines and an international consensus’ recommendation on PJI were published, providing a consistent approach to PJI management. We undertook a study to compare outcomes of PJI managed in accordance with IDSA versus those managed outside of the same. Methods: This retrospective cohort study of a consecutive series of patients who had total joint replacement (TJR) with subsequent deep PJI was undertaken to determine historical clinical variation relative to recently established management guidelines. All operations were completed at one arthroplasty center over a 5-year period predating IDSA guideline development. Results: Of 8505 patients who had TJR, 267 (3.1%) were diagnosed with subsequent PJI. Of these, 42/8505 (0.5%) had culture positive deep PJI, with 38/42 (90.5%) managed surgically. The odds of treatment failure among cases not managed in accordance with IDSA were 11 times greater as compared to guideline-accordant cases (OR 11, 95%CI 1.84-65.7; P =0.006). This difference was most pronounced among those who had irrigation and debridement. We could not demonstrate any significant difference in treatment success or failure for one-stage or two-stage exchange. Conclusions: Surgical management of PJI in accordance with existing guidelines can optimize success of PJI treatment. In particular, aggressive surgical treatment (including prosthesis removal) is likely warranted in patients who had symptoms of PJI for longer than 3 wk. In a patient in whom deviation from existing guidelines is considered, it is important for physicians to weigh the risk of inferior outcome and counsel the patient accordingly.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it