The EBJIS definition of periprosthetic joint infection

Aims The diagnosis of periprosthetic joint infection (PJI) can be difficult. All current diagnostic tests have problems with accuracy and interpretation of results. Many new tests have been proposed, but there is no consensus on the place of many of these in the diagnostic pathway. Previous attempts to develop a definition of PJI have not been universally accepted and there remains no reference standard definition. Methods This paper reports the outcome of a project developed by the European Bone and Joint Infection Society (EBJIS), and supported by the Musculoskeletal Infection Society (MSIS) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Implant-Associated Infections (ESGIAI). It comprised a comprehensive review of the literature, open discussion with Society members and conference delegates, and an expert panel assessment of the results to produce the final guidance. Results This process evolved a three-level approach to the diagnostic continuum, resulting in a definition set and guidance, which has been fully endorsed by EBJIS, MSIS, and ESGIAI. Conclusion The definition presents a novel three-level approach to diagnosis, based on the most robust evidence, which will be useful to clinicians in daily practice. Cite this article: Bone Joint J 2021;103-B(1):18–25.

A Conceptual Framework for Integrated Ecosystem Assessment

This short communication presents an ecosystem assessment framework developed within ESMERALDA; a Horizon2020-funded EU project aimed at delivering a ‘flexible methodology’ to assist towards pan-European and regional Mapping and Assessment of Ecosystem Services (MAES). The framework we present is closely aligned with assessment frameworks developed within the MAES (2014) and Millennium Ecosystem Assessment (2010) initiatives. Mapping, fundamental to the work of MAES as well as ESMERALDA, is placed at the heart of a wider suite of activities carried out within ecosystem assessment. This enables flexibility in where and how integration takes place. Beyond the biophysical parameters at the core of the framework, emphasis is given to the inclusion of social and economic factors to ensure policy relevance. Consultation, both internal to the ESMERALDA Consortium and external - amongst those already conducting ecosystem assessments across Europe - helped guide the development of the framework. Online consultation will provide information about the development of guidance around the framework and initiate the collation of good practice examples. The framework and accompanying guidance will contribute towards a final guidance tool due at the end of the ESMERALDA project lifetime.