Advantages of a MultidisciplinaryTeam in the Treatment of Boneand Joint Infections
DOI:
https://doi.org/10.82189/spot.60Keywords:
Arthritis, Infectious/drug therapy, Arthritis, Infectious/therapy, Clinical Decision‑Making, Patient Care TeamAbstract
Bone and joint infections represent a significant source of morbidity and mortality, often termed a “silent epidemic.” While native infections, such as septic arthritis and osteomyelitis, still persist, surgical site infections related to orthopedic implants have gained particular prominence due to their growing prevalence and complexity. These infections not only lead to substantial patient morbidity and mortality but also create a significant burden on healthcare resources through prolonged hospital stays, multiple surgeries and extended antibiotic therapy. We advocate for the adoption of a multidisciplinary approach in treating bone and joint infections, drawing on the experiences of an existing multidisciplinary team. The integration of orthopedic surgeons, infectious disease specialists, internal medicine professionals and microbiologists enables a more comprehensive diagnostic and therapeutic approach, offering tailored surgical and antibiotic strategies based on the specific infection and the patient’s overall circumstances. Based on existing international examples and the experience of the authors, this paper proposes the establishment of a structured multidisciplinary approach in the Portuguese setting to optimize patient care and healthcare resources use.Downloads
References
Lemaignen A, Bernard L, Marmor S, Ferry T, Grammatico-Guillon L, Astagneau P, et al. Epidemiology of complex bone and joint infections in France using a national registry: The CRIDAc network. J Infect. 2021;82:199-206. doi: 10.1016/j.jinf.2020.12.010.
Markus Rupp, Edmund Leu, Steven M Kurtz, Alt V. Projections of Primary TKA and THA in Germany From 2016 Through 2040. Clin Orthop Related Res. 2020; 478:1622-33.
Court-Brown CM, Duckworth AD, Clement ND, McQueen MM. Fractures in older adults. A view of the future? Injury. 2018;49:2161-6.
Lum ZC, Natsuhara KM, Shelton TJ, Giordani M, Pereira GC, Meehan JP. Mortality During Total Knee Periprosthetic Joint Infection. J Arthroplasty. 2018 ;33:3783-8.
Natsuhara KM, Shelton TJ, Meehan JP, Lum ZC. Mortality During Total Hip Periprosthetic Joint Infection. J Arthroplasty. 2019;34:S337-S42.
Premkumar A, Kolin DA, Farley KX, Wilson JM, McLawhorn AS, Cross MB, et al. Projected Economic Burden of Periprosthetic Joint Infection of the Hip and Knee in the United States. J Arthroplasty. 2021;36:1484-9 e3.
Sousa A, Carvalho A, Pereira C, Reis E, Santos AC, Abreu M, et al. Economic Impact of Prosthetic Joint Infection - an Evaluation Within the Portuguese National Health System. J Bone Jr. Infect.Jnr. 2018;3:197-202.
Iliaens J, Onsea J, Hoekstra H, Nijs S, Peetermans WE, Metesmakers WJ. Fracture-related infection in long bone fractures: A comprehensive analysis of the economic impact and influence on quality of life. Injury. 2021;52:3344-9.
Specchia ML, Frisicale EM, Carini E, Di Pilla A, Cappa D, Barbara A, et al. The impact of tumor board on cancer care: evidence from an umbrella review. BMC Health Serv Res. 2020;20:73.
Ferry T, Steng P, Mainard D, Jenny JY, Laurent F, Senneville E, et al. The CRIDAc healthcare network in France: A nationwide Health Ministry program to improve the management of bone and joint infection. Orthop Traumatol Surg Res. 2019;105:185-90.
Zijstra WP, Ploegmakers JJ, Kampinga GA, Toren-Wielema ML, Etterna HB, Knobben BAS, et al. A protocol for periprosthetic joint infections from the Northern Infection Network for Joint Arthroplasty (NNUA) in the Netherlands. Arthroplasty. 2022;4:19.
Carlson VR, Deleyser GJ, Certain L, Pupalood J, Gilliand JM, Anderson LA, Clinical Experience With a Coordinated Multidisciplinary Approach to Treating Prosthetic Joint Infection. Arthroplast Today. 2020;6:360-2.
Sambri A, Fiore M, Tedeschi S, De Paolis M. The Need for Multidisciplinary in Modern Medicine: An Insight into Orthopaedic Infections. Microorganisms. 2022;31:10.
McNally M, Sousa R, Wouthuysen-Bakker M, Chen AF, Soriano A, Vogely HC, et al. The EBJIS definition of periprosthetic joint infection. Bone Joint J. 2021;103:8:18-25.
Metasmakers WJ, Morgenstern M, McNally MA, Moriarty TF, McFadyen I, Scarborough M, et al. Fracture-related infection: A consensus on definition from an international expert group. Injury. 2018;49:505-10.
Jenkins N, Hughes H, Howl do it... How infection doctors approach the PJI MDT. Knee. 2020;27:199-47.
Laurent E, Lemaignan A, Gras G, Druon J, Fevre K, Abgueguen P, et al. Multidisciplinary team meeting for complex bone and joint infections diagnosis: The PHICTOS study. Rev Epidemiol Sante Publique. 2019;67:149-54.
England N. 2013/14 NHS Standard contract for bone and joint infection service specification [adult] section b part 1 - service specifications. 2013 [14 Jan 2023]; Available from: https://www.england.nhs.uk/wp-content/uploads/2017/2/04/02/hone-joint-infec.pdf.
Ferreira L, Pos E, Nogueira DR, Ferreira FP, Sousa R, Abreu MA. Antibiotics with antibiotin activity - rifampicin and beyond. Front Microbiol. 2024;15:1435720. doi: 10.3388/fmich.2024.1435720.
Bauer S, Bouldouyne MA, Oufella A, Palmari P, Bakir R, Fabreguettes A, et al. Impact of a multidisciplinary staff meeting on the quality of antibody therapy prescription for bone and joint infections in orthopedic surgery. Med Mal Infect. 2012;42:603-7.
Santos Silva M, Sousa A, Rodrigues C, Serrano P, Sousa R. Determinants of sucess in the treatment of prosthetic joint infection with debridement, antibiotics and implant retention. Acta Orthop Belgica. 2021;87 e supplement 1:123-9.
Sousa R, Carvalho A, Santos AC, Abreu MA. Optimal microbiological sampling for the diagnosis of osteoarticular infection. EFORT Open Rev. 2021;6:390-8.
Bose D, Kugan R, Stubbs D, McNally M. Management of infected nonunion of the long bones by a multidisciplinary team. Bone Joint J. 2015;97:B814-7.
Akgun D, Muller M, Perka C, Winkler T. High cure rate of periprosthetic hip joint infection with multidisciplinary team approach using standardized two-stage exchange. J Orthop Surg Res. 2019;14:78.
Dias Carvalho A, Ribau A, Soares D, Santos AC, Abreu M, Sousa R. Combined antibiotic therapy spacers either commercial or handmade are superior to monotherapy: a microbiological analysis at the second stage of revision. J Bone Jt Infect. 2021;6:305-12.
Sanidad ML [26]. Tratamientos de las infecciones osteoarticulares resistentes Hj. [updated 26/09/202114/01/2023]: Available from: https://www.mscbs.gob.es/professionales/CentrosDeReferencia/docs/Fesp/Fesp26.pdf.
van Sloten M, Gomez-Junyert J, Ferry T, Rossi N, Petersdorf S, Lange J, et al. Should all patients with a culture-negative periprosthetic joint infection be treated with antibiotics? : a multicentre observational study. Bone Joint J. 2022;104:818-8.
Shohat N, Goswami K, Tan TL, Yayac M, Soriano A, Sousa R, et al. 2020 Frank Stinchfield Award: Identifying who will fail following irrigation and debridement for prosthetic joint infection. Bone Joint J. 2020;102:B11-9.
Lowik CA, Parvizi J, Jutta PC, Zijstra WP, Knobben BA, Xu C, et al. Debridement, antibiotics and implant retention is a viable treatment option for early periprosthetic joint infection presenting more than four weeks after index arthroplasty. Clin Infect Dis. 2020;71:630-6. doi: 10.1093/cid/cb367.
Beldman M, Lowik C, Soriano A, Albisch L, Zijstra WP, Knobben BAS, et al. If, when, and how to use rifampin in acute staphylococcal periprosthetic joint infections, a multicentre observational study. Clin Infect Dis. 2021;73:1634-41. doi: 10.1093/cid/cisb426. Erratum in: Clin Infect Dis. 2022;74:1680. doi: 10.1093/cid/cisc149.
Barros LH, Barbosa TA, Esteves J, Abreu M, Soares D, Sousa R. Early Debridement, antibiotics and implant retention [DMR] in patients with suspected acute infection after hip or knee arthroplasty - safe, effective and without negative functional impact. J Bone Jt Infect. 2019;43:005.
Sousa R, Silva M, Sousa A, Esteves J, Neves P, Seabra-Lopes J, et al. Tratamento de Infecções Protésicas com Desbridamento e Preservação do Implanto - resultados da aplicação prospectiva de um protocolo pré-estabelecido. Rev Port Ortop Traumatol. 2017;25:16-27.
Sousa R, Esteves J, Sousa A, Silva M, Ramos J, Lopes S, et al. Tratamento de Infecções Protésicas com Cirurgia de Revisão a Dois Tempos - resultados de um estudo prospectivo com abordagem protocolada. Rev Port Ortop Trauma. 2017;25.
Cipriano A, Santos PV, Dias R, Carvalho A, Reis E, Pereira C, et al. Adult Native Joint Septic Arthritis: A Nine-Year Retrospective Analysis in a Portuguese University Hospital. Acta Med Port. 2021;34:826-32. doi: 10.20344/amp.12998.
Ravn C, Neyt J, Bentio N, Abreu MA, Achermann Y, Bozhkova S, et al. Guideline for management of septic arthritis in native joints [SANJO]. J Bone Jt Infect. 2023;8:293-7.
Ribau AJ, Collins JE, Chen AF, Sousa RJ. Is Preoperative Staphylococcus aureus Screening and Decolonization Effective at Reducing Surgical Site Infection in Patients Undergoing Orthopedic Surgery? A Systematic Review and Meta-Analysis With a Special Focus on Elective Total Joint Arthroplasty. J Arthroplasty. 2021;36:752-66 e6.
Sousa RJ, Abreu MA, Wouthuysen-Bakker M, Soriano AV. Is Routine Urinary Screening Indicated Prior To Elective Total Joint Arthroplasty? A Systematic Review and Meta-Analysis. J Arthroplasty. 2019;34:1523-30. doi: 10.1016/j.arthr.2019.03.034.
Sousa R, Barreira P, Leita P, Santos AC, Ramos MH, Oliveira A. Preoperative Staphylococcus aureus Screening/Decolonization Protocol Before Total Joint Arthroplasty-Results of a Small Prospective Randomized Trial. J Arthroplasty. 2016;31:234-9.
Sousa R, Munoz-Mahamud E, Queyle J, Dias da Costa L, Casals C, Scott P, et al. Is asymptomatic bacterium a risk factor for prosthetic joint infection? Clin Infect Dis. 2014 ;59:417. doi: 10.1093/cid/cid235.
Neves P, Forte H, Barreira P, Pinto A, Santos AC, Araújo Abreu M, et al. Adequate Microbiological Intraoperative Investigation in Prosthetic Joint Infections - reflexions on our experience with an emphasis on implant sonication. Rev Port Ortop Traumatol. 2020;28:207-17.
Vale JS, Castelo FS, Barros BS, Ribau AC, Carvalho AD, Sousa RJ. Synovial Fluid Biomarkers for the Diagnosis of Periprosthetic Joint Infection:A Systematic Review and Meta-Analysis of Their Diagnostic Accuracy According to Different Definitions. J Arthroplasty. 2023;382:731-2738.e3. doi: 10.1016/j.arthr.2023.06.017.
Diniz SE, Ribau A, Vinha A, Oliveira JC, Abreu MA, Sousa R. Simple and inexpensive synovial fluid biomarkers for the diagnosis of prosthetic joint infection according to the new EBJIS definition. J Bone Jt Infect. 2023;8:109-16.
Shohat N, Bauer T, Buttaro M, Budhigaram N, Cashman J, Delia Valle CJ, et al. Hip and Knee Section, What is the Definition of a Periprosthetic Joint Infection [RJI] of the Knee and the Hip? Can the Same Criteria be Used for Both Joints?: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty. 2019;34:5325-57.
Sousa R, Ribau A, Alfaro P, Burch MA, Ploegmakers J, McNally M, et al. The European Bone and Joint Infection Society definition of periprosthetic joint infection is meaningful in clinical practice: a multicentric validation study with comparison with previous definitions. Acta Orthop. 2023;94:8-18.
McNally M, Sigmund I, Hotchen A, Sousa R. Making the diagnosis in prosthetic joint infection: a European view. EFORT Open Rev. 2023;8:253-63.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Ricardo Sousa, Miguel Araújo Abreu
This work is licensed under a Creative Commons Attribution 4.0 International License.
