Ein interdisziplinärer und standardisierter Diagnostik- und Therapiealgorithmus für periprothetische Gelenkinfektionen
Bibliographic record
Abstract
Introduction: Since 06/2013, periprosthetic joint infections (PJI) were treated with a standardized therapeutic and diagnostic algorithm in a separated septic-surgery department by an interdisciplinary team of surgeons, orthopedics, microbiologist, and pathologists. The hypothesis is put up, that such an interdisciplinary and standardized approach is able to improve the outcome compared to a conventional procedure. Methods: Publications 1 and 2 are retrospective studies, the third a prospective consecutive study. Results: Publication 1: 95 PJI cases, treated with a two-stage exchange in the interdisciplinary and standardized system in the years 2013 – 2016, were included (49 hips, 46 knees). The comparison group was a non-standardized, non-interdisciplinary and conventionally treated group from the same clinic of the years 2009 – 2011 (46 hips, 40 knees). Despite a significantly higher CCI (Charlson Comorbidity Index, 3.9, 3.1, P=0.009), rate of septic indicated pre-revisions (52.6%, 36%, p=0.025), and trend towards a higher average age (69.0 years, 66.2 years, p=0.075) and more polymicrobial cases (47.3%, 33.7%, p=0.062), both the relapse rate (suspected infection persistence), and time interval between ex- and reimplantation (66.6 days, 80.7 days, p<0.001), could be reduced significantly form 10.4% to 3.1% (p=0.048). In contrast, no significant reduction of a new infection rate (suspected different/new infection) could be shown (8.4%, 8.1%, p=0.945) in a 2-year follow-up. Publication 2: In 24 hip- and 16 knee PJI of the interdisciplinary treated group, the indication for a two-stage exchange was based only on (para-)clinical signs without a preoperative microbe detection (symptoms, CRP > 1mg/dl, X-ray, Leucocytes in aspiration >1700/µl). In 91.6%, a microbe was then found intraoperatively in the hip. In the knee, this was only the case in 68.7%. However, here other definitive infection signs were found in 93.7% (e.g. Krenn Morawietz type II/III). Publication 3: In the years 2015/16, 8 PJI with co-existing fractures were identified (one Vancouver Typ B1, three type B2/3, four type C). Following a specialized and standardized three-step procedure (explanation, fracture stabilization, two-stage reimplantation) the combined relapse and new infection rate was 12.5%, the total revision rate 37.5% and the fracture healing rate 62.5% (follow-up 34±8 months). Conclusion: An interdisciplinary and standardized treatment system is one possible solution for the increasing problem of PJI. The indication for a revision can solely be based on paraclinical criteria without a preoperative microbe detection. A standardized three step-based procedure in PJI with co-existing fractures achieved infection consolidation and limb preservation in all cases.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.012 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| 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 itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".