Use of intra-operative fluorescence imaging in periprosthetic joint infection: State of the art and future perspectives

Issue title: Special Section: Future Arthroplasty

Guest editors: Mustafa Citak

Article type: Review Article

Authors: De Mauro, Domenico^{a; b; c} | Salber, Jochen^d | Stimolo, Davide^{a; e} | Florian, Ende^f | Citak, Mustafa^{a; *}

Affiliations: [a] Helios ENDO-Klinik, Hamburg, Germany | [b] Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, Rome, Italy | [c] Department of Public Health, Orthopedic Unit, “Federico II” University, Naples, Italy | [d] Department of Experimental Surgery, Center for Clinical Research, Ruhr-Universität, Bochum, Germany | [e] Department of Orthopedics, Musculoskeletal Oncology Unit, University of Florence, Florence, Italy | [f] Medac GmbH, Wedel, Germany

Correspondence: [*] Corresponding author: Mustafa Citak, Helios ENDO-Klinik, Holstenstraße, 2, 22767 Hamburg, Germany. E-mail: [email protected].

Abstract: BACKGROUND: In periprosthetic joint infections (PJIs), the surgeon’s role becomes pivotal in addressing the infection locally, necessitating the surgical removal of infected and necrotic tissue. Opportunity to enhance the visualization of infected tissue during surgery could represent a game-changing innovation. OBJECTIVE: The aim of this narrative review is to delineate the application of intraoperative fluorescence imaging for targeting infected tissues in PJIs. METHODS: A systematic review, adhering to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, was carried out. The search included multiple online database; MEDLINE, Scopus, and Web of Science. For data extraction the following were evaluated: (i) diagnosis of musculoskeletal infection; (ii) use of intraoperative fluorescence imaging; (iii) infected or necrotic tissues as target. RESULTS: Initially, 116 studies were identified through online database searches and reference investigations. The search was narrowed down to a final list of 5 papers for in-depth analysis at the full-text level. Subsequently, 2 studies were included in the review. The study included a total of 13 patients, focusing on cases of fracture-related infections of the lower limbs. CONCLUSION: The primary and crucial role for orthopedic surgeons in PJIs is the surgical debridement and precise removal of necrotic and infected tissue. Technologies that enable clear and accurate visualization of the tissue to be removed can enhance the eradication of infections, thereby promoting healing. A promising avenue for the future involves the potential application of intraoperative fluorescence imaging in pursuit of this objective.

Keywords: Intraoperative fluorescence imaging, periprosthetic joint infections, total joint arthroplasty, necrotic tissue, 5-aminolevulinic acid

DOI: 10.3233/THC-240479

Journal: Technology and Health Care, vol. 32, no. 5, pp. 3635-3641, 2024