Comparison of Delphi Consensus Criteria and Musculoskeletal Infection Society Outcome Reporting Tool (MSIS-ORT) Definitions of Successful Surgical Treatment of Periprosthetic Knee Infection

Background Agreement on success following surgical treatment for periprosthetic joint infection (PJI) is important for comparing the efficacy of different surgical approaches with varying consequences and outcomes and setting patient expectations. We compared success rates following two-stage exchange arthroplasty for knee PJI using two expert-consensus definitions of success. Methods Prospectively documented data for 57 knees treated by a single surgeon at an academic tertiary care center were retrospectively reviewed. Treatment outcomes were quantified using the Delphi Consensus Criteria and the Musculoskeletal Infection Society Outcome Reporting Tool (MSIS ORT). Results Success rates were 81% using the Delphi Consensus Criteria and 56% using the MSIS ORT (P = 0.008). The MSIS ORT success rates increased to 76% when aseptic revisions and deaths unrelated to PJI were not penalized as failures of treatment. Predicted probabilities of successful treatment in a hypothetical case scenario were lowest based on the MSIS ORT and similarly higher using Delphi Consensus Criteria and MSIS ORT modified for both women (53.0, 90.8, and 88.7%) and men (29.1, 89.1, and 89.3%). Conclusions Study observations underscore the need for a uniformly accepted single definition of surgical treatment success.