Diagnosis of Periprosthetic Joint Infection—An Algorithm-Based Approach

• Published in: The Journal of arthroplasty Vol. 32; no. 7; pp. 2047 - 2050
• Main Authors: Ting, Nicholas T., Della Valle, Craig J.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2017
• Subjects: AAHKS symposium; Aged; Algorithms; Arthritis, Infectious - diagnosis; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Knee - adverse effects; Blood Sedimentation; C-Reactive Protein - analysis; complications; diagnosis; Female; Humans; Intraoperative Care; Male; Orthopedics; periprosthetic joint infection; Prosthesis-Related Infections - blood; Prosthesis-Related Infections - diagnosis; Prosthesis-Related Infections - etiology; Surgeons; Synovial Fluid - cytology; total joint arthroplasty; periprosthetic joint infection; diagnosis; total joint arthroplasty; complications; AAHKS symposium
• ISSN: 0883-5403; 1532-8406; 1532-8406
• DOI: 10.1016/j.arth.2017.02.070

Periprosthetic joint infection (PJI) remains one of the most challenging and devastating modes of failure after total hip and knee arthroplasties. Despite the profound urgency and impact of PJI on an individual and societal basis, historically, there have not been standardized definitions of and diagnostic algorithms for infection after total joint arthroplasty. In a recent symposium, the American Academy of Hip and Knee Surgeons put forth a standardized approach to the prevention, diagnosis, and management of the patient with a suspected PJI. This review article summarizes these findings, and reviews the algorithmic approach to the diagnosis of PJI. The diagnosis of PJI is easily made in our experience in 90% of patients by getting an erythrocyte sedimentation rate and C-reactive protein followed by selective aspiration of the joint if these values are elevated or if the clinical suspicion is high. Synovial fluid obtained should be sent for a synovial fluid white blood cell count, differential, and cultures.