Discrepancies in Periprosthetic Joint Infection Diagnostic Criteria Reporting and Use: A Scoping Review and Call for a Standard Reporting Framework.

Abstract

Background: Numerous criterion-based definitions of periprosthetic joint infection (PJI) with differing criteria and point systems have been published, but the frequency of their use or application to study methods in publications on PJI has not been evaluated. Assessing the use of these definitions in studies is an important step to ensuring the validity and reproducibility of PJI research and to determining best practices for the application of these definitions in future research.

Questions/purposes: As a scoping review, we identified and evaluated studies published since 2012 that defined PJI, and we asked: (1) Which of those definitions are cited most frequently in other peer-reviewed publications? (2) How often are the definition criteria and scoring systems reported in the methods beyond the name or citation or modified from the published definition? (3) How often did the PJI definition stated in a citing study's methods section fail to align with the definition provided in the cited source?

Methods: To identify published PJI definition citations, we queried PubMed for studies on PJI published between January 1, 2012, and August 1, 2023, identifying 75 unique citations in studies with human patients diagnosed with PJI. This study focused on PJI definitions detailing specific clinical and laboratory criteria for PJI, recognizing and including six formal definitions for PJI presented across 16 publications: the 2011 Musculoskeletal Infection Society (MSIS), 2013 MSIS/International Consensus Meeting (ICM), 2013 Infectious Disease Society of America (IDSA), 2018 ICM, and 2021 European Bone and Joint Infection Society (EBJIS) definitions, and an unendorsed 2018 Definition. Back citation of these 16 publications identified 457 studies (Journal of Arthroplasty n = 285, Clinical Orthopaedics and Related Research n = 69, Bone and Joint Journal n = 58, Journal of Bone and Joint Surgery n = 45) published between January 1, 2012, and December 31, 2022, that cited one of the identified PJI definition citations. Trends in PJI definition citation and reporting were assessed based on the following criteria: (1) the PJI definition claimed in the methods, (2) the cited reference to this claim, (3) the description of the definition in the manuscript, and (4) the definition modification.

Results: Of 457 studies published between 2012 and 2022 that cited at least one PJI definition, the most cited was the 2011 MSIS definition (40% [183 studies]), followed by the 2013 MSIS/ICM definition (30% [139]), the unendorsed 2018 Definition (14% [65]), the 2018 ICM definition (3.7% [17]), the 2013 IDSA definition (3.5% [16]), and the 2021 EBJIS definition (one study); 7.9% (36) cited multiple definitions. Overall, 31% (141 of 457) of studies detailed the PJI definition beyond its name and citation. Authors modified definitions in 18% (83 of 457) of studies. Of the 98 studies using a definition with an inconclusive category, 18% (18 of 98) provided details on the inconclusive group. The PJI definition stated in the methods section did not align with the cited source in 19% (86 of 457) of studies. Of these, 85% (73 of 86) cited the unendorsed 2018 Definition while claiming use of an endorsed definition.

Conclusion: The 2011/2013 MSIS definitions of PJI remain commonly cited through 2022 despite the availability of newer definitions. Many studies on PJI definitions suffer from a lack of methodological transparency, hindering both reproducibility and the assessment of their validity. There also exists an alarming rate of citation errors and widespread use of unendorsed scoring systems despite claims of adherence to accepted standards, representing a systematic error in the existing scientific record.

Clinical relevance: In response to these findings, we recommend that academic societies establish a standard reporting framework and checklist for studies using formal PJI definitions, such as those that exist for systematic reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA]), randomized trials (Consolidated Standards of Reporting Trials [CONSORT]), and observational studies (Strengthening the Reporting of Observational Studies in Epidemiology [STROBE]). The MSIS and EBJIS, as discussed in an accompanying letter to the editor, are creating an endorsed standard reporting framework that aims to improve reporting transparency in the PJI research.