The Joint Specific BACH classification: A Predictor of Outcome in Prosthetic Joint Infection

Description

In this presentation, Martina Wismayer, a registrar at Thames Valley, discusses her work on the JS BACH classification concerning periprosthetic joint infections (PJI). She outlines the significant morbidity and financial burden caused by PJIs, emphasizing the need for a multi-disciplinary team (MDT) approach to successful treatment. Wismayer explains that management currently varies between hospitals and surgeons, with no clear criteria for assessing case complexity or guiding referrals to specialist centers.



The BACH classification, introduced in 2019, sorted patients based on bone involvement complexity, antibiotic susceptibility, soft tissue quality, and overall patient health. She categorizes patients as uncomplicated, complex, or limited options based on the severity of their conditions. Wismayer highlights that this classification effectively predicts treatment outcomes for osteomyelitis and has now been adapted to include specific PJI elements.



She outlines the aims of her study, which included evaluating the classification's feasibility and its potential to predict clinical and patient-reported outcomes. The study involved prospective identification of patients from major bone infection centers, and only those with confirmed infections were included. Wismayer shares that the study assessed joint status and recurrence rates as part of its outcomes, with 220 patients monitored over a median follow-up of 4.7 years.



Data shows that the classification effectively indicated risks of recurrence and treatment outcomes, with significant differences in success rates among the categorized patients. Limitations of the study included potential censored data due to patient follow-up issues and the small number of upper limb infections.



Wismayer anticipates future developments such as an online tool for assessing patient-specific recurrence risks, emphasizing the classification's utility in guiding pre-operative discussions regarding treatment options.

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