Abstract
Management of periprosthetic joint infections (PJIs) requires accurate diagnosis in order to maximize the chance of infection eradication. The work up of a painful and potentially infected joint replacement requires a systematic approach. The American Academy of Orthopaedic Surgeons (AAOS) and the Musculoskeletal Infection Society have set guidelines for diagnosis and definition of PJI, respectively. The only recommended intraoperative test for establishment of infection is intraoperative frozen section from multiple representative areas surrounding the prosthesis in question. The use of Gram stain is discouraged. Synovial cell counts of intraoperative aspiration and leukocyte esterase can be helpful when such information is not available preoperatively. Newer techniques involving sonication, polymerase chain reaction (PCR), gene expression, and synovial fluid biomarkers show promise in improving bacterial yields, but their precise roles remain to be determined.
Keywords
- Periprosthetic Joint Infection
- Leukocyte Esterase
- Infection Detection
- Synovial Fluid White Blood Cell
- Synovial Fluid White Blood Cell Count
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Popescu A, Doyle RJ. The gram stain after more than a century. Biotech Histochem. 1996;71:145–51.
Biswas BB, Basu PS, Pal MK. Gram staining and its molecular mechanism. Int Rev Cytol. 1970;29:1–27.
Brannan SR, Jerrard DA. Synovial fluid analysis. J Emerg Med. 2006;30:331–9.
Beveridge TJ. Use of gram stain in mircrobiology. Biotech Histochem. 2001;76:111–8.
Della Valle C, Parvizi J, Bauer TW, et al. Diagnosis of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg. 2010;18:760–70.
Spanghel MJ, Masterson E, Masri BA, et al. The role of intraoperative gram stain in the diagnosis of infection during revision total hip arthroplasty. J Arthroplasty. 1999;14:952–6.
Parvizi J, Ghanem E, Menashe S, et al. Periprosthetic infection: what are the diagnostic challenges? J Bone Joint Surg Am. 2006;88:138–47.
Morgan PM, Sharkey P, Ghanem E, et al. The value of intraoperative gram stain in revision total knee arthroplasty. J Bone Joint Surg Am. 2009;91:2124–9.
Banit DM, Kaufer H, Hartford JM. Intraoperative frozen section analysis in total joint arthroplasty. Clin Orthop Relat Res. 2002;401:230–8.
Simmons TD, Stern SH. Diagnosis and management of the infected total knee arthroplasty. Am J Knee Surg. 1996;9:99–106.
Burnett RS, Kelly MA, Hanssen AD, et al. Technique and timing of two stage exchange for infection in TKA. Clin Orthop Relat Res. 2007;464:164–78.
Wong YC, Lee QJ, Wai YL, et al. Intraoperative frozen section for detecting active infection in failed hip and knee arthroplasties. J Arthroplasty. 2005;20:1015–20.
Parvizi J, Zmistowski B, Berbari EF, et al. New definition for periprosthetic joint infection. Clin Orthop Relat Res. 2001;469:2292–4.
Parvizi J, Ghanem E, Sharkey P, et al. Diagnosis of infected total knee: findings of a multicenter database. Clin Orthop Relat Res. 2008;466:2628–33.
Ghanem E, Parvizi J, Burnett RS, et al. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg Am. 2008;90-A:1637–43.
Bedair H, Ting N, Jacovides C, et al. The Mark Coventry Award: diagnosis of early postoperative TKA infection using synovial fluid analysis. Clin Orthop Relat Res. 2011;469:34–40.
Cipriano CA, Brown NM, Micheal AM, et al. Serum and synovial fluid analysis for diagnosing chronic periprosthetic infection in patients with inflammatory arthritis. J Bone Joint Surg Am. 2012;94-A:594–600.
Wetters NG, Berend KR, Lombardi AV, et al. Leukocyte esterase reagent strips for rapid diagnosis of periprosthetic joint infection. J Arthroplasty. 2012;27:8–11.
Parvizi J, Jacovides C, Antoci V, et al. Diagnosis of periprosthetic joint infection : the utility of a simple yet unappreciated enzyme. J Bone Joint Surg Am. 2011;93-A:2242–8.
Berbari EF, Marculescu C, Sia I, et al. Culture negative prosthetic joint infection. Clin Infect Dis. 2007;45:1113–9.
Piper KE, Jacobson MJ, Cofield RH, et al. Microbiologic diagnosis of prosthetic shoulder infection by use of implant sonication. J Clin Microbiol. 2009;47:1878–84.
Trampuz A, Piper KE, Jacobson MJ, et al. Sonication of removed hip and knee prosthesis for diagnosis of infection. N Eng J Med. 2007;357:654–63.
Holinka J, Bauer L, Hirschl AM, et al. Sonication cultures of explanted components as an add on test to routinely conducted microbiologic diagnostics improve pathogen detection. J Orthop Res. 2011;29:617–22.
Gallo J, Raska M, Dendis M, et al. Molecular diagnosis of prosthetic joint infection. A review of evidence. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2004;148:123–9.
Arciola CR, Montanaro L, Consterton JW. New trends in diagnosis and control strategies for implant infections. Int J Artif Organs. 2011;34:727–36.
Esteban J, Alonso-Rodriguez N, Del Prado G, et al. PCR hybridization after sonication improves diagnosis of implant related infection. Acta Orthop. 2012;83:299–304.
Achermann Y, Vogt M, Leunig M, et al. Improved diagnosis of periprosthetic joint infection by multiplex PCR of sonication fluid from removed implants. J Clin Microbiol. 2010;48:1208–14.
Deirmengian C, Lonner JH, Booth RE. The Mark Coventry Award: white blood cell gene expression: a new approach toward the study and diagnosis of infection. Clin Orthop Relat Res. 2005;440:38–44.
Diermengian C, Hallab N, Tarabishy A, et al. Synovial fluid biomarkers for periprosthetic infection. Clin Orthop Relat Res. 2010;468:2017–23.
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Lee, GC., Kim, R.H. (2014). Intraoperative Tests to Aid in Diagnosis of Periprosthetic Joint Infection. In: Springer, B., Parvizi, J. (eds) Periprosthetic Joint Infection of the Hip and Knee. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7928-4_6
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DOI: https://doi.org/10.1007/978-1-4614-7928-4_6
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