Emerging Technologies for the Diagnosis of Periprosthetic Infection.

Abstract

The diagnosis of periprosthetic joint infection remains challenging and relies on a combination of clinical history, physical examination findings, and laboratory tests. The Musculoskeletal Infection Society (MSIS) convened a panel of experts to develop criteria for diagnosing periprosthetic joint infection1. The criteria developed by the workgroup currently represent the most commonly used definition of periprosthetic joint infection. The workgroup identified two major criteria that were indicative of periprosthetic joint infection: (1) the presence of a communicating sinus tract with the prosthesis or (2) the isolation of a pathogen from two different tissue or fluid samples from the joint. In addition, the workgroup identified six minor criteria and indicated that diagnosis of periprosthetic joint infection was very likely when four of the following six criteria were present: (1) an elevated erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) level2, (2) an elevated synovial white blood-cell (WBC) count, (3) an elevated level of synovial polymorphonucleocytes (PMNs), (4) the presence of purulence, (5) the isolation of one pathogen in tissue or fluid, or (6) more than five neutrophils per high-powered field …