Related Experiment Video
Updated: Jan 28, 2026
Implantation of an Isoproterenol Mini-Pump to Induce Heart Failure in Mice
Published on: October 3, 2019
Correlation of histological and microbiological findings in septic and aseptic knee implant failure
Y Inagaki1,2, Y Uchihara1,2, M Munemoto1,2
1Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal and Clinical Laboratory Services, University of Oxford, Nuffield Orthopaedic Centre, OX3 7HE, Oxford, UK.
Introduction:
The Musculoskeletal Infection Society (MSIS) has defined specific clinical and laboratory criteria for the diagnosis of periprosthetic joint infection (PJI). In this study we assessed the diagnostic utility of MSIS microbiological and histological criteria for PJI in 138 cases of septic and aseptic knee implant failure.
Materials And Methods:
Intra-operative samples from 60 cases of knee septic implant failure (SIF) and 78 cases of aseptic implant failure (AIF), defined on the basis of clinical, laboratory and operative findings/surgical management, were analysed microbiologically and histologically. Findings were correlated with the final clinical diagnosis and the specificity, sensitivity, accuracy, positive and negative predictive value of MSIS microbiological and histological criteria for knee PJI were assessed.
Results:
80% of SIF cases showed culture of the same organism from two or more samples (ie MSIS microbiological criteria for definite PJI); 8.3% grew an organism from one sample, and 11.7% showed no growth from any sample. 23.1% of AIF cases grew an organism from one sample and 76.9% showed no growth from any sample. MSIS histological criteria for PJI identified 96.7% of SIF cases. The sensitivity, specificity, accuracy and positive and negative predictive value of MSIS histological criteria for PJI were 96.7%, 100%, 98.6%, 100% and 97.5%, respectively. MSIS microbiological and histological criteria identified all AIF cases.
Conclusions:
Knee PJI is more often identified by current MSIS histological than microbiological criteria. A significant proportion of SIF cases show either no growth or growth of an organism from only one sample. AIF is identified by both MSIS microbiological and histological criteria. Correlation of clinical, radiological and laboratory findings is required for the diagnosis of knee PJI.
Insights
Histological criteria from the Musculoskeletal Infection Society (MSIS) are more effective for diagnosing periprosthetic joint infection (PJI) than microbiological criteria. Both methods accurately identified aseptic implant failure in knee revision cases.
Area of Science:
- Orthopedic surgery
- Infectious disease diagnostics
- Biomaterials science
Background:
- Periprosthetic joint infection (PJI) diagnosis relies on criteria from the Musculoskeletal Infection Society (MSIS).
- Evaluating the diagnostic performance of MSIS criteria in knee implant failure cases is crucial.
Purpose of the Study:
- To assess the diagnostic utility of MSIS microbiological and histological criteria for PJI.
- To compare the effectiveness of MSIS criteria in septic versus aseptic knee implant failure.
Main Methods:
- Analysis of intra-operative samples from 138 knee implant failures (60 septic, 78 aseptic).
- Microbiological and histological examination of samples.
- Correlation of findings with clinical diagnosis and calculation of diagnostic values (sensitivity, specificity, accuracy, predictive values).
Main Results:
- MSIS histological criteria identified 96.7% of septic implant failure (SIF) cases with high accuracy (98.6%).
- Microbiological criteria showed varied results in SIF, with 80% meeting definite PJI criteria.
- Both MSIS microbiological and histological criteria successfully identified all aseptic implant failure (AIF) cases.
Conclusions:
- Histological criteria demonstrate superior diagnostic performance for knee PJI compared to microbiological criteria.
- A significant percentage of SIF cases lack definitive microbiological evidence.
- Accurate knee PJI diagnosis necessitates integrating clinical, radiological, and laboratory findings.
Related Concept Videos
02:20Correlations
01:28History of Microbiology
01:28Three-Dimensional Microscopy in Microbiology
01:27Correlation and Causation
Correlation versus Causation
If the dependent variable increases or decreases when the independent variable increases, there is a positive or negative...
01:23Knee Joint
A total of seven ligaments support the knee joint. The patellar ligament, which is also attached to the quadriceps femoris...
01:29Two-Dimensional Microscopy in Microbiology