Related Experiment Video
Updated: May 31, 2026
A Periprosthetic Joint Candida albicans Infection Model in Mouse
Published on: February 2, 2024
Definition of periprosthetic joint infection: is there a consensus?
Javad Parvizi1, Christina Jacovides, Benjamin Zmistowski
1The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA. parvj@aol.com
Background:
The diagnosis of periprosthetic joint infection (PJI) continues to pose a challenge. While many diagnostic criteria have been proposed, a gold standard for diagnosis is lacking. Use of multiple diagnostic criteria within the joint arthroplasty community raises concerns in patient treatment and comparison of research pertaining to PJI.
Questions/Purposes:
We (1) determined the variation in existing diagnostic criteria, (2) compared the existing criteria to a proposed new set of criteria that incorporates aspirate cell count analysis, and (3) investigated the variations between the existing criteria and the proposed criteria.
Patients And Methods:
We retrospectively identified 182 patients undergoing 192 revision knee arthroplasties who had a preoperative joint aspiration analysis at our institution between April 2002 and November 2009. We excluded 20 cases due to insufficient laboratory parameters, leaving 172 cases for analysis. We applied six previously published sets of diagnostic criteria for PJI to determine the variation in its incidence using each set of criteria. We then compared these diagnostic criteria to our proposed new criteria and investigated cases where disagreement occurred.
Results:
We identified 41 cases (24%) in which at least one established criteria set classified the case as infected while at least one other criteria set classified the case as uninfected. With our proposed criteria, the infected/uninfected ratio was 92/80. The proposed criteria had a large variance in sensitivity (54%-100%), specificity (39%-100%), and accuracy (53%-100%) when using each of the established criteria sets as the reference standard.
Conclusions:
The discrepancy between definitions of infection complicates interpretation of the literature and the treatment of failed TKAs owing to PJI. Based on our findings, we suggest establishing a common set of diagnostic criteria utilizing aspirate analysis to improve the treatment of PJI and facilitate interpretation of the literature.
Level Of Evidence:
Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Insights
Diagnosing periprosthetic joint infection (PJI) is challenging due to varied criteria. A new approach using joint fluid analysis showed potential for more consistent PJI diagnosis and improved patient treatment.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Medical Diagnostics
Background:
- Periprosthetic joint infection (PJI) diagnosis remains a significant clinical challenge.
- Lack of a gold standard and use of multiple diagnostic criteria complicate patient management and research comparison.
- Variability in PJI diagnostic criteria hinders consistent treatment and literature interpretation.
Purpose of the Study:
- To determine the variation among existing diagnostic criteria for PJI.
- To compare current PJI diagnostic criteria with a novel set incorporating aspirate cell count analysis.
- To investigate discrepancies between established and proposed PJI diagnostic criteria.
Main Methods:
- Retrospective analysis of 172 revision knee arthroplasty cases with preoperative joint aspiration.
- Application of six published PJI diagnostic criteria sets to identify variations in infection incidence.
- Comparison of existing criteria with a proposed set, analyzing cases with disagreement.
Main Results:
- Significant variation in PJI diagnosis was observed, with 24% of cases classified differently by established criteria.
- The proposed criteria yielded an infected/uninfected ratio of 92/80.
- The proposed criteria demonstrated wide variance in sensitivity (54%-100%) and specificity (39%-100%) against reference standards.
Conclusions:
- Discrepancies in PJI diagnostic definitions complicate the interpretation of research and treatment of failed knee arthroplasties.
- Establishing a unified set of diagnostic criteria, including aspirate analysis, is recommended.
- Standardized PJI diagnostic criteria are crucial for improving treatment and facilitating literature review.
Related Concept Videos
01:25Endocarditis I: Introduction
01:26Healthcare Associated Infections I: Iatrogenic, Exogenic and Endogenic
HAIs significantly increase the cost of health care. Extended stays in healthcare institutions, increased disability, increased costs of medications, including specialized antibiotics, and prolonged recovery times add to the patient's expenses and the healthcare institution and funding bodies. Common...
01:22Pericarditis I: Introduction
01:18Endocarditis III: Medical Management
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...