Diagnosing Periprosthetic Joint Infection: Cultures, Molecular Markers, and the Ibis Technology

Abstract

Lack of a standard definition or uniformly accepted diagnostic criteria offers a challenge to the management of prosthetic joint infection (PJI). Even traditional cultures fail to provide a gold standard for PJI diagnosis (Fig. Parvizi 2011). Culture results depend on the sample obtained, with results often varying based on the location and method of specimen collection. Reliability of cultures depends on obtaining representative samples (including multiple tissue samples and synovial fluid) and a skilled microbiologist interpreting growth patterns. Furthermore, experts disagree on whether broth or solid media should be used for diagnostic cultures and on the number of colonies grown in culture that are needed to qualify for a positive culture. In addition, low growth rate and the frequent presence of rare organisms in cultures limit the sensitivity of culture analyses. Culture results are also limited as they merely act to confirm a preoperative diagnosis since tissue samples are obtained during a surgical procedure.