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Imaging approach to prosthetic joint infection

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Abstract

The diagnosis of prosthetic joint infection (PJI) remains challenging, despite multiple available laboratory tests for both serum and synovial fluid analysis. The clinical symptoms of PJI are not always characteristic, particularly in the chronic phase, and there is often significant overlap in symptoms with non-infectious forms of arthroplasty failure. Further exacerbating this challenge is lack of a universally accepted definition for PJI, with publications from multiple professional societies citing different diagnostic criteria. While not included in many of the major societies’ guidelines for diagnosis of PJI, diagnostic imaging can play an important role in the workup of suspected PJI. In this article, we will review an approach to diagnostic imaging modalities (radiography, ultrasound, CT, MRI) in the workup of suspected PJI, with special attention to the limitations and benefits of each modality. We will also discuss the role that image-guided interventions play in the workup of these patients, through ultrasound and fluoroscopically guided joint aspirations. While there is no standard imaging algorithm that can universally applied to all patients with suspected PJI, we will discuss a general approach to diagnostic imaging and image-guided intervention in this clinical scenario.

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  1. Department of Radiology, NYU Langone Medical Center, New York, NY, USA

    Meghan Jardon, Jan Fritz & Mohammad Samim

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  1. Meghan Jardon
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Key points

• Diagnostic imaging is frequently utilized in the workup of prosthetic joint infection (PJI), despite lack of clear consensus on the specific role of each modality.

• MRI is the optimal diagnostic modality for PJI, as it has high sensitivity and specificity for PJI when metal artifact reduction techniques are utilized.

• Image-guided prosthetic joint aspirations allow for synovial fluid analysis that is critical to diagnosing PJI, with newer synovial laboratory markers demonstrating higher diagnostic performance than culture.

• Although “dry” image-guided joint aspirations are more common in patients without PJI, dry taps in the setting of hip PJI are commonly due to dehiscence of the prosthesis pseudocapsule.

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Jardon, M., Fritz, J. & Samim, M. Imaging approach to prosthetic joint infection. Skeletal Radiol (2023). https://doi.org/10.1007/s00256-023-04546-7

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