The Zeitgeist of Challenging the Evidence. A Perspective on the International Consensus Meeting on Periprosthetic Joint Infection

Document Type: PERSPECTIVE

Authors

Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA

Abstract

 
Background: The economic burden of the treatment of periprosthetic joint infection (PJI) is high and the treatment of PJI has a high degree of international controversy. Several papers have declared the International Consensus Meeting on Periprosthetic Joint Infection (ICMPJI) to be the "flawless pledge of international academics" to overcome the challenges of musculoskeletal infections. The purpose of this paper is to highlight for the first time some essential insights into the key dilemmas that are associated with this international consensus process.
Methods: The proceedings of the ICMPJI was reviewed, and the critical consensus agreements that were reached were communicated via e-mail to 48 leading orthopaedic surgeons, microbiologists and statisticians around the world. Of these, 30 responded, 8 did not, and 10 of respondents were not aware of the ICMPJI.
Results: A thorough review of the ICMPJI proceedings identified a clear need to resolve some of the dilemmas that we highlight in this paper. The Delphi procedure has been described as a survey technique that enables a group dynamic-based practice. Although there have been several published reports on this procedure, its scientific merit is still being debated. Several challenges and questions have been raised regarding the application of the Delphi technique, but there is no doubt that it is a vital approach for achieving consensus on subjects where none currently exists.
Conclusion: Performing prospective clinical studies in this area is currently the best and only option to overcome this challenge. In the long term, this approach will not only incorporate the standard of clinical evidence but also adopt regional mores for treating infection, which include patient values, cultural differences and local financial resources.

Keywords

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1. Parvizi J, Gehrke T. Proceedings of the international
consensus meeting on periprosthetic joint infection. J
Arthroplasty. 2014; 29(2):4.
2. Heiko A. Consensus measurement in Delphi studies:
review and implications for future quality assurance.
Technol Forecast Soc Change. 2012; 79(8):1525-36.
3. Dalkey NC, Helmer O. An experimental application of
the Delphi method to the use of experts. Manag Sci.
1963; 9(3):458–67.
4. Rieger WG. Directions in Delphi developments:
dissertations and their quality. Technol Forecast Soc
Change. 1986; 29(2):195–204.
5. Parente FJ, Anderson-Parente JK. Delphi inquiry
systems. In: Wright G, Ayton P, editors. Judgmental
forecasting. Chichester: Wiley; 1987. P. 129-56.
6. Berg JE, Nelson FD, Rietz TA. Prediction market accuracy
in the long run. Int J Forecast. 2008; 24(2):285–300.
7. Gustafson DH, Shukla RK, Delbecq A, Walster GW.
A comparative study of differences in subjective
likelihood estimates made by individuals, interacting
groups, Delphi groups, and nominal groups. Organ
Behav Hum Perform. 1973; 9(2):280–91.
8. Turoff M. The design of a policy Delphi. Technol
Forecast Soc Change. 1970; 2(2):149-71.
9. Parente R, Anderson-Parente J. A case study of longterm
Delphi accuracy. Technol Forecast Soc Change.
2011; 78(9):1705-11.
10. Linstone H. Eight basic pitfalls: a checklist. In:
Linstone HA, Turoff M, editors. The Delphi method:
techniques and applications. Boston: Addison-
Wesley; 2002. P. 559-71.
11. Van de Ven AH, Delbecq AL. The effectiveness of
nominal, Delphi, and interacting group decision making
processes. Acad Manage J. 1974; 17(4):605–21.
12. Martino JP. Technological forecasting for decision
making. NewYork: McGraw Hill, Inc; 1993.
13. Huckfeldt VE, Judd RC. Issues in large scale Delphi
studies. Technol Forecast Soc Change. 1974; 6(1):75–88.
14. Landeta J. El método Delphi. Una técnica de previsión
del future. Barcelona: Ariel; 1999.
15. Rowe G, Wright G. The Delphi technique: past, present,
and future prospects-Introduction to the special issue.
Technol Forecast Soc Change. 2011; 78(9):1487-90.
16. Bañuls VA, Turoff M. Scenario construction via Delphi
and cross-impact analysis. Technol Forecast Soc
Change. 2011; 78(9):1579–1602.
17. Nowack M, Endrikat J, Guenther E. Review of
Delphi-based scenario studies: quality and design
considerations. Technol Forecast Soc Change. 2011;
78(9):1603–15.
18. Tapio P, Paloniemi R, Varho V, Vinnari M. The unholy
marriage? Integrating qualitative and quantitative
information in Delphi processes. Technol Forecast Soc
Change. 2011; 78(9):1616–28.
19. Landeta J, Barrutia J, Lertxundi A. Hybrid Delphi: a
methodology to facilitate contribution from experts in professional contexts. Technol Forecast Soc Change.2011; 78(9):1629–41.
20. Rowe G, Wright G. The Delphi technique as a
forecasting tool: issues and analysis. Int J Forecast.
1999; 15(4):353–75.
21. Keeney S, Hasson F, McKenna H. Consulting the oracle:
ten lessons from using the Delphi technique in nursing
research. J Adv Nurs. 2006; 53(2):205-12.
22. Becker GE, Roberts T. Do we agree? Using a Delphi
technique to develop consensus on skills of hand
expression. J Hum Lact. 2009; 25(2):220-5.
23. Achermann Y, Vogt M, Leunig M, Wüst J, Trampuz A.
Improved diagnosis of periprosthetic joint infection
by multiplex PCR of sonication fluid from removed
implants. J Clin Microbiol. 2010; 48(4):1208-14.
24. Phelan DM, Osmon DR, Keating MR, Hanssen AD.
Delayed reimplantation arthroplasty for candidal
prosthetic joint infection: a report of 4 cases and
review of the literature. Clin Infect Dis. 2002;
34(7):930–8.
25. Darouiche RO, Hamill RJ, Musher DM, Young EJ, Harris
RL. Periprosthetic candidal infections following
arthroplasty. Rev Infect Dis. 1989; 11(1):89–96.
26. Azzam K, Parvizi J, Jungkind D, Hanssen A, Fehring T,
Springer B, et al. Microbiological, clinical, and surgical
features of fungal prosthetic joint infections: a multiinstitutional
experience. J Bone Joint Surg Am. 2009;
91(Suppl 6):142–9.
27. Baumann PA, Cunningham B, Patel NS, Finn
HA. Aspergillus fumigatus infection in a mega
prosthetic total knee arthroplasty: salvage by staged
reimplantation with 5-year follow-up. J Arthroplasty.
2001; 16(4):498–503.
28. Yilmaz M, Mete B, Ozaras R, Kaynak G, Tabak F,
Tenekecioglu Y, et al. Aspergillus fumigatus infection
as a delayed manifestation of prosthetic knee
arthroplasty and a review of the literature. Scand J
Infect Dis. 2011; 43(8):573–8.
29. Biring GS, Kostamo T, Garbuz DS, Masri BA, Duncan
CP. Two-stage revision arthroplasty of the hip for
infection using an interim articulated Prostalac hip
spacer: a 10- to 15-year follow-up study. J Bone
Joint Surg Br. 2009; 91(11):1431–7.
30. Mahmud T, Lyons MC, Naudie DD, Macdonald SJ,
McCalden RW. Assessing the gold standard: a review of
253 two-stage revisions for infected TKA. Clin Orthop
Relat Res. 2012; 470(10):2730–6.
31. Malekzadeh D, Osmon DR, Lahr BD, Hanssen AD,
Berbari EF. Prior use of antimicrobial therapy is a risk
factor for culture-negative prosthetic joint infection.
Clin Orthop Relat Res. 2010; 468(8):2039–45.
32. Del Pozo JL, Patel R. Infection associated with
prosthetic joints. N Engl J Med. 2009; 361(8):787-94.
33. Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni
KK, Osmon DR, et al. Sonication of removed hip and
knee prostheses for diagnosis of infection. N Engl J
Med. 2007; 357(7):654-63.
34. Janz V, Wassilew GI, Hasart O, Matziolis G, Tohtz S, Perka
C. Evaluation of sonicate fluid cultures in comparison
to histological analysis of the periprosthetic
membrane for the detection of periprosthetic joint
infection. Int Orthop. 2013; 37(5):931-6.
35. Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J.
Economic burden of periprosthetic joint infection
in the United States. J Arthroplasty. 2012; 27(8
Suppl):61–5.e1.
36. Wright JG, Swiontkowski MF, Heckman JD. Introducing
levels of evidence to the journal. J Bone Joint Surg Am.
2003; 85-A(1):1-3.