Culture-negative periprosthetic joint infections

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Medical Diagnostics

Background:

• Culture-negative periprosthetic joint infections (CN-PJI) present diagnostic and management difficulties, with an incidence of 7-15%.
• Fungi and mycobacteria are implicated in over 85% of CN-PJI cases, alongside fastidious bacteria.
• Advanced molecular techniques for pathogen identification are often inaccessible and expensive.

Purpose of the Study:

• To review current diagnostic tests for CN-PJI.
• To provide a straightforward clinical algorithm for diagnosing CN-PJI.
• To assist surgeons in maximizing diagnostic accuracy for PJI and identifying causative organisms.

Main Methods:

• Literature review of diagnostic tests for CN-PJI.
• Synthesis of information on established and emerging diagnostic modalities.
• Development of a simplified clinical algorithm for CN-PJI diagnosis.

Main Results:

• Several straightforward, low-cost methods can aid in CN-PJI diagnosis.
• Advanced techniques like PCR and NGS offer potential but face accessibility and cost barriers.
• A practical diagnostic algorithm is proposed to guide clinicians.

Conclusions:

• Accessible diagnostic strategies are crucial for managing CN-PJI effectively.
• The proposed algorithm can improve the identification of causative pathogens in CN-PJI.
• Further research into cost-effective diagnostic tools for CN-PJI is warranted.