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Diagnosis of Periprosthetic Joint Infection: An Algorithmic Approach to Patients

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Periprosthetic Joint Infection of the Hip and Knee

Abstract

Identification of periprosthetic joint infection (PJI) is critical, as the treatment between infected and noninfected arthroplasties is fundamentally different and missing the diagnosis will lead to recurrent failure. Yet in the absence of a true gold standard, the diagnosis of PJI can often be elusive. Although every clinical scenario requires clinical judgment, by maintaining an algorithmic approach to the diagnosis of PJI, the clinician can most effectively use the battery of tests that are available for diagnosis. Relying on a patient’s risk factors, physical exam, and plain radiographs allows a particular patient to be stratified into either a high-probability or a low-probability category for PJI, which will allow better interpretation of subsequent tests and guide how aggressively the diagnosis of PJI is pursued. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) should be obtained in all patients where a revision is planned or if a source for pain is being sought. If positive or if the clinical suspicion for PJI is high, a joint aspiration should be performed and the fluid sent for a synovial fluid white blood cell (WBC) count, differential, and culture. Intraoperative testing can be performed in cases where the diagnosis of PJI has not been confirmed or excluded preoperatively. Given the rising incidence of this problem and the growing infection burden anticipated in coming years, much effort is being put toward improving diagnostic tests for PJI. Emerging technology, such as synovial fluid biomarker analysis, PCR, and sonication, as well as the increasing availability of serum markers, such as IL-6, may improve our ability to identify PJI in the future.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA

    H. John Cooper M.D.

  2. Department of Orthopaedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL, 60612, USA

    Craig J. Della Valle M.D.

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  1. OrthoCarolina Hip and Knee Center, Charlotte, North Carolina, USA

    Bryan D. Springer

  2. Rothman Institute of Orthopedics, Philadelphia, Pennsylvania, USA

    Javad Parvizi

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Cooper, H.J., Valle, C.J.D. (2014). Diagnosis of Periprosthetic Joint Infection: An Algorithmic Approach to Patients. 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_5

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