Orthopedic joint infection prevention: Key takeaways from the 2018 International Consensus Meeting on Musculoskeletal Infection


The 2018 International Consensus Meeting on Musculoskeletal Infection convened in Philadelphia from July 25 to 27 at Thomas Jefferson University.

The meeting involved delegates from several orthopedic subspecialties, including spine, trauma, foot and ankle, shoulder and elbow, oncology, pediatrics and sports medicine. The attendees participated in 18 workgroups to evaluate literature, extract evidence for current practices and identify the further need for research. The participants also evaluated the level of evidence for each recommendation.

Industry representatives, including individuals from government organizations, payers and business administration, attended the meeting but did not vote during the consensus process. MSIS was founded in 1989 to advance knowledge in the field of musculoskeletal infection.

Javad Parvizi, MD, the James Edwards Professor of Orthopaedic Surgery at the Sidney Kimmel Medical College and orthopedic surgeon at Rothman Institute, both in Philadelphia, discusses the meeting and where trends are headed in the future:

Question: How has the event grown from the first meeting held in 2013?

Dr. Javad Parvizi: The event this time included delegates from other subspecialties in orthopedics that included spine, trauma, foot and ankle, shoulder and elbow, pediatrics, oncology and sports. Hence, the number of delegates who attended the meeting were over twice as much.

Q: What were the main takeaways from the meeting? Which recommendations do you see being the most important?

JP: There were numerous recommendations that will change our practices. A total of 650 questions were discussed and voted on. Almost all, with the exception of a few, passed consensus and majority were strong consensus. For example, there is a recommendation that we should avoid adding topical antibiotics to irrigation solution during surgery and instead consider using sterile povodine iodine solution. Hundreds of recommendations were made that will directly impact our daily practices with the goal of improving patient care.

Q: How has the level of evidence and information around periprosthetic joint infection changed over the past few years?

JP: In recent years, and with more attention to this issue, there have been numerous studies that have added to our understanding of orthopedic infections. One of the great accomplishments of the consensus meeting is to identify areas in desperate need of studies. During the consensus in 2013 we had generated a large list of subjects that needed to be investigated.

Since 2013, a large number of high-level studies have been done that allowed us to make better recommendations this time. In addition, our industry partners, having recognized orthopedic infections as a real issue for the patients, have started to innovate and bring great products into the market. One of the problems facing introduction of these technologies is the FDA and regulatory approval. We had members of the FDA in attendance during the 2018 consensus. They observed the process and the discussions. The FDA and other regulatory bodies have recognized orthopedic infections as a major issue also. They are doing what they can to allow innovations to find their way into the clinical practice while protecting the patient population.

I believe the discussions that took place over three days may have brought all of us closer to recognizing what the issues are and what can be done to address them.

Q: Where do you see the biggest opportunity for growth and development in periprosthetic joint infection prevention in the future?

JP: In line with what I said above, the greatest opportunity for us is to avoid practices that are not only ineffective, but [also] could be dangerous for the patients and the society. The example I gave you above, though simple, can have wide reaching consequences. The CDC and the governmental agencies across the globe are worried about the emergence of antimicrobial resistance.

The consensus made numerous recommendations that show our commitment to antibiotic stewardship while improving care for the patients. We, as physicians, have the duty to exercise social responsibilities while doing what is right for the given individual patient. The consensus document will prove that these two duties are complementary and not contradictory.

The consensus has identified numerous areas in need of further investigations and innovations also. This will allow us to work with our industry partners, regulatory agencies and scientists to bring further innovations to clinical practice and make the lives of our patients suffering [the] devastating and disastrous complication[s] of infection, better.

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