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Diagnostic value of the CD 15 focus score in two-stage revision arthroplasty of periprosthetic joint infections

High specificity in diagnosing infect eradication

Diagnostische Bedeutung des CD15-Fokus-Score bei zweizeitigem Gelenkendoprothesenwechsel

Hohe Spezifität für die Diagnose einer Infekteradikation

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An Erratum to this article was published on 06 July 2021

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Abstract

Introduction

The purpose of this study is to use the CD15 focus score (FS) to determine the sensitivity and specificity of bacterial infection persistence in spacer-based two-stage revision arthroplasty.

Methods

The analysis comprises 112 cases that were subjected to revision due to the presence of infection upon replacement of a joint endoprosthesis. The histopathological data were collected in accordance with the synovial-like interface membrane (SLIM) classification and the CD15-FS and correlated with the microbiological data (MD). The quantifying evaluation of the CD15-FS was performed without knowledge regarding the microbiological data (MD). Correlation with the MD was performed after a 14-day cultivation period.

Results

With a single evaluation (1 focus, field area: 1.2 mm2) with a score value of 42, the CD15-FS showed a sensitivity for the eradication of infections of 0.64 and a specificity of 0.79 (PPV = 0.5; NPV = 0.87). With tenfold evaluation (10 foci, field area: 12 mm2) with a score value of 220, the sensitivity for the eradication was 0.68, the specificity 0.91 (PPV = 0.7; NPV = 0.89). No statistically significant correlation between the score values and the different infectious species could be detected. Based on the MD in 112 cases the rate of infection eradication was 75%. Polymethylmethacrylate-particles (PMMA) were detected in the perispacertissue in 64 cases (58%). No significant correlation could be established between microbiological pathogen detection and the presence of PMMA.

Conclusion

In all cases (n = 112), periimplant synovial tissue (SLIM) with variable fibroblastic cellularity, capillary proliferation, leukocytic infiltration, fibrin deposition, new formation of woven bone and detection of PMMA particles was observed. These cases were classified as type IX perispacer synovialis/SLIM: type IX‑A with histopathological infection eradication and type IX‑B with histopathological infection persistence.

Zusammenfassung

Hintergrund

Ziel der Arbeit war es, mittels des CD15-Fokus-Scores (FS) eine Aussage zu Sensitivität und Spezifität der bakteriellen Infektpersistenz bei Spacer-basiertem zweizeitigem Gelenkendoprothesenwechsel zu ermitteln.

Methoden

Die Stichprobe umfasste 112 Fälle in denen aufgrund einer Infektion bei einem Gelenkendoprothesenwechsel eine Revision erfolgte. Die histopathologischen Daten wurden gemäß der SLIM-Klassifikation („synovial-like interface membrane“) und des CD15-FS erhoben und mit den mikrobiologischen Daten korreliert. Die quantifizierende Bewertung durch den CD15-FS erfolgte ohne Kenntnis der mikrobiologischen Daten(MD). Die Korrelation erfolgte erst nach Einhaltung einer 14-tägigen Kultivierung.

Ergebnisse

Der CD15-FS zeigte bei einfacher Auswertung eine Sensitivität für die Infekteradikation von 0,64 und eine Spezifität von 0,79 (PPV = 0,5; NPV = 0,87). Bei 10-facher Auswertung ergab sich eine Sensitivität von 0,68 und eine Spezifität von 0,91 (PPV = 0,7; NPV = 0,89). Es ließ sich kein signifikanter Zusammenhang mit den infektiösen Spezies nachweisen. Den MD zufolge betrug die Rate der Infekteradikation 75 %. In 64 Fällen bestand ein Partikelnachweis (Polymethylmethacrylat [PMMA]). Es konnte kein signifikanter Zusammenhang zwischen Erregernachweis und Präsenz von PMMA gezeigt werden.

Schlussfolgerung

In sämtlichen Fällen zeigte sich periimplantäres Gewebe mit variabler fibroblastischer Zellularität, Kapillarproliferation, Leukozyteninfiltration, Fibrinablagerung, Neubildung von Geflechtknochen und Nachweis von PMMA. Die Klassifikation erfolgte als Synovialis vom Perispacertyp – Typ 9, entsprechend Typ 9A mit histopathologischer Infekteradikation oder Typ 9B mit histopathologischer Infektpersistenz.

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Acknowledgements

Special thanks are due to the employees of MVZ-HZMD-Trier GmbH, Ms. S. Giak, Ms. C. Soika and Ms. S. Klee, for the data collection and input of clinical as well as microbiological findings, especially in the context of preparation of the histopathological findings.

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Authors and Affiliations

  1. MVZ-Zentrum für Histologie, Zytologie und Molekulare Diagnostik Trier GmbH, Max-Planck-Straße 5, 54296, Trier, Germany

    C. Liewen &  V. Krenn

  2. Fakultät für Medizin, Sigmund Freud PrivatUniversität Wien, Vienna, Austria

    V. T. Krenn & M. Liebisch

  3. Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany

    R. Dieckmann

  4. St. Josef-Stift Sendenhorst, Sendenhorst, Germany

    L. Bause

  5. Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    A. Niemeier

  6. Center for Musculoskeletal Surgery (CMSC), Charité—Universitätsmedizin Berlin, Berlin, Germany

    A. Trampuz

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Correspondence to V. Krenn.

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Conflict of interest

C. Liewen, V.T. Krenn, R. Dieckmann, L. Bause, M. Liebisch, A. Niemeier, A. Trampuz, and V. Krenn declare that there is no conflict of interest with regard to the contents of this publication. Regardless of a possible conflict of interest, this scientific contribution is independent and product neutral.

This article does not include any studies performed on humans or animals. The Ethics Committee of the State Medical Association of Rhineland-Palatinate, Mainz, Germany, has issued a positive vote under the reference number 837.400.15 (10168), “CD 15 Quantifizierung (CD 15 Focus Score) als Basis der periprothetischen Infektionsdiagnostik: Subspezifizierung der bakteriellen Infektion in niedrigpathogene und hochpathogenen Bakterien” (English: “CD 15 quantification (CD 15 focus score) as the basis of periprosthetic infection diagnosis: sub-specification of bacterial infection in low-pathogenic and highly pathogenic bacteria”), in which it is stated that there are no ethical or legal concerns.

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Redaktion

U. Müller-Ladner, Bad Nauheim

U. Lange, Bad Nauheim

Doctoral thesis by Caroline Liewen

These data represent a part of Caroline Liewen’s doctoral thesis at the Charité University Medicine, Berlin (supervisor of the thesis: Prof. Dr. med. Veit Krenn).

The original online version of this article was revised: In the original online version of the article, Figure 2 was incorrect.

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Liewen, C., Krenn, V.T., Dieckmann, R. et al. Diagnostic value of the CD 15 focus score in two-stage revision arthroplasty of periprosthetic joint infections. Z Rheumatol 81, 342–351 (2022). https://doi.org/10.1007/s00393-020-00941-w

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