New Definition for Periprosthetic Joint Infection: From the Workgroup of the Musculoskeletal Infection Society

  • Javad ParviziEmail author
  • Benjamin Zmistowski
  • Elie F. Berbari
  • Thomas W. Bauer
  • Bryan D. Springer
  • Craig J. Della Valle
  • Kevin L. Garvin
  • Michael A. Mont
  • Montri D. Wongworawat
  • Charalampos G. Zalavras
Symposium: Papers Presented at the 2010 Meeting of the Musculoskeletal Infection Society


Periprosthetic joint infection (PJI) is one of the most challenging and frequent complications after lower-extremity joint (hip and knee) arthroplasty. However, there is no single accepted set of diagnostic criteria for PJI. Various definitions have been proposed; however, none have been widely adopted. Furthermore, some of these definitions disagree with each other [14]. Therefore, a workgroup convened by the Musculoskeletal Infection Society (MSIS) analyzed the available evidence to propose a new definition for PJI. A summary of recommendations of those in attendance at a premeeting workshop of the 21st Annual Meeting of the MSIS on August 4, 2011, pertaining to the definition of PJI is outlined below. Existing published data on the definition of PJI was discussed by e-mail in the preceding 6 months by the executive members of the MSIS and a group of experts with known interest in this field. The intention of this proposal is to have a “gold standard” definition for PJI...


Acne Periprosthetic Joint Infection Periprosthetic Fracture Periprosthetic Tissue Inflammatory Arthropathy 
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.



We thank the following individuals for their involvement and invaluable input throughout the development of this document: Robert Barrack MD, Keith Berend MD, Sandra Berrios-Torres (from Centers for Disease Control and Prevention), Kevin Bozic MD, John Esterhai MD, Ryan Fagan (from Centers for Disease Control and Prevention), Thomas Fehring MD, Terry Gioe MD, Teresa Horan (from Centers for Disease Control and Prevention), Steven Kurtz PhD, Bas Masri MD, Arvind Nana MD, Douglas Osmon MD, John Segreti MD, and Mark Spangehl MD.


  1. 1.
    Bedair H, Ting N, Jacovides C, Saxena A, Moric M, Parvizi J, Della Valle CJ. The Mark Coventry Award. Diagnosis of early postoperative TKA infection using synovial fluid analysis. Clin Orthop Relat Res. 2011;469:34–40.PubMedCrossRefGoogle Scholar
  2. 2.
    Berbari E, Mabry T, Tsaras G, Spangehl M, Erwin PJ, Murad MH, Steckelberg J, Osmon D. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am. 2010;92:2102–2109.PubMedCrossRefGoogle Scholar
  3. 3.
    Bilgen O, Atici T, Durak K, Karaeminoğullari, Bilgen MS. C-reactive protein values and erythrocyte sedimentation rates after total hip and total knee arthroplasty. J Int Med Res. 2001;29:7–12.PubMedGoogle Scholar
  4. 4.
    Deirmengian C, Hallab N, Tarabishy A, Della Valle C, Jacobs JJ, Lonner J, Booth RE. Synovial fluid biomarkers for periprosthetic infection. Clin Orthop Relat Res. 2010;468:2017–2023.PubMedCrossRefGoogle Scholar
  5. 5.
    Della Valle CJ, Sporer SM, Jacobs JJ, Berger RA, Rosenberg AG, Paprosky WG. Preoperative testing for sepsis before revision total knee arthroplasty. J Arthroplasty. 2007;22(6 Suppl 2):90–93.PubMedCrossRefGoogle Scholar
  6. 6.
    Di Cesare PE, Chang E, Preston CF, Liu CJ. Serum interleukin-6 as a marker of periprosthetic infection following total hip and knee arthroplasty. J Bone Joint Surg Am. 2005;87:1921–1927.PubMedCrossRefGoogle Scholar
  7. 7.
    Ghanem E, Ketonis C, Restrepo C, Joshi A, Barrack R, Parvizi J. Periprosthetic infection: where do we stand with regard to Gram stain? Acta Orthop. 2009;80:37–40.PubMedCrossRefGoogle Scholar
  8. 8.
    Ghanem E, Parvizi J, Burnett RS, Sharkey PF, Keshavarzi N, Aggarwal A, Barrack RL. 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;90:1637–1643.PubMedCrossRefGoogle Scholar
  9. 9.
    Larsson S, Thelander U, Friberg S. C-reactive protein (CRP) levels after elective orthopedic surgery. Clin Orthop Relat Res. 1992;275:237–242.PubMedGoogle Scholar
  10. 10.
    Mariani BD, Martin DS, Levine MJ, Booth RE Jr, Tuan RS. The Coventry Award. Polymerase chain reaction detection of bacterial infection in total knee arthroplasty. Clin Orthop Relat Res. 1996;331:11–22.PubMedCrossRefGoogle Scholar
  11. 11.
    Parvizi J, Ghanem E, Menashe S, Barrack RL, Bauer TW. Periprosthetic infection: what are the diagnostic challenges? J Bone Joint Surg Am. 2006;88(Suppl 4):138–147.PubMedCrossRefGoogle Scholar
  12. 12.
    Parvizi J, Jacovides C, Adeli B, Jung KA, Hozack WJ. Mark B. Coventry Award. Synovial C-reactive protein: A prospective evaluation of a molecular marker for periprosthetic knee joint infection. Clin Orthop Relat Res. 2011 July 23 [Epub ahead of print].Google Scholar
  13. 13.
    Parvizi J, Jacovides C, Antoci V Jr, Ghanem E. Diagnosis of periprosthetic joint infection: The role of a simple, yet unrecognized enzyme. J Bone Joint Surg Am. 2011;90(24).Google Scholar
  14. 14.
    Parvizi J, Jacovides C, Zmistowski B, Jung KA. Definition of periprosthetic joint infection: Is there a consensus? Clin Orthop Relat Res. 2011 July 13 [Epub ahead of print].Google Scholar
  15. 15.
    Schinsky MF, Della Valle CJ, Sporer SM, Paprosky WG. Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty. J Bone Joint Surg Am. 2008;90:1869–1875.PubMedCrossRefGoogle Scholar
  16. 16.
    Trampuz A, Hanssen AD, Osmon DR, Mandrekar J, Steckelberg JM, Patel R. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med. 2004;117:556–562.PubMedCrossRefGoogle Scholar
  17. 17.
    Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, Mandrekar JN, Cockerill FR, Steckelberg JM, Greenleaf JF, Patel R. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007;357:654–663.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Javad Parvizi
    • 1
    Email author
  • Benjamin Zmistowski
    • 1
  • Elie F. Berbari
    • 2
  • Thomas W. Bauer
    • 3
  • Bryan D. Springer
    • 4
  • Craig J. Della Valle
    • 5
  • Kevin L. Garvin
    • 6
  • Michael A. Mont
    • 7
  • Montri D. Wongworawat
    • 8
  • Charalampos G. Zalavras
    • 9
  1. 1.The Rothman Institute of Orthopaedics at Thomas Jefferson University HospitalPhiladelphiaUSA
  2. 2.Division of Infectious DiseasesMayo ClinicRochesterUSA
  3. 3.Department of Anatomic PathologyThe Cleveland Clinic FoundationClevelandUSA
  4. 4.Department of Orthopaedic SurgeryOrthoCarolina Hip and Knee CenterCharlotteUSA
  5. 5.Department of Orthopaedic SurgeryRush University Medical CenterChicagoUSA
  6. 6.Department of OrthopaedicsUniversity of Nebraska Medical CenterOmahaUSA
  7. 7.Center for Joint Preservation and ReplacementRubin Institute for Advanced Orthopedics, Sinai Hospital of BaltimoreBaltimoreUSA
  8. 8.Department of Orthopaedic SurgeryLoma Linda University Medical CenterLoma LindaUSA
  9. 9.Department of Orthopaedic SurgeryUniversity of Southern California, LAC+USC Medical CenterLos AngelesUSA

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