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Acute Pyelonephritis II: Diagnostic Studies and Management01:28

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Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
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Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
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Diagnostic algorithm in septic total knee arthroplasty failure - What is evidence-based?

Christian Suren1, Igor Lazic1, Maximilian Stephan1

  • 1Department of Orthopedics and Sports Orthopedics, Klinikum Rechts der Isar, Technical University of Munich (TUM), Ismaningerstr. 22, 81675, Munich, Germany.

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|February 19, 2021
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Summary

Diagnosing prosthetic joint infection (PJI) after knee replacement is complex. This overview examines current diagnostic criteria and algorithms, highlighting synovial fluid analysis and tissue biopsies as key for accurate PJI detection.

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Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Diagnostic Medicine

Background:

  • Prosthetic joint infection (PJI) is a major cause of total knee arthroplasty failure, presenting significant diagnostic challenges.
  • Existing PJI definitions rely on various criteria due to the lack of a single definitive diagnostic test, impacting comparability.
  • Navigating the evolving evidence and applying definitions effectively requires clear diagnostic algorithms.

Purpose of the Study:

  • To review the latest evidence on diagnostic parameters used in established PJI definitions.
  • To present and compare existing algorithmic approaches for PJI diagnosis.
  • To provide clarity on the diagnostic cascade for prosthetic joint infections.

Main Methods:

  • Literature review focusing on diagnostic parameters within established PJI definitions.
  • Analysis of clinical symptoms, serological markers (CRP, ESR, D-Dimer), and imaging modalities.
  • Evaluation of arthrocentesis, synovial fluid analysis, periprosthetic tissue biopsies, and the alpha-Defensin test.
  • Comparison of published diagnostic algorithms from organizations like AAOS, MSIS, and the German Society for Arthroplasty.

Main Results:

  • Clinical symptoms have limited diagnostic value, with fistula presence being the only consistently included symptom.
  • CRP and ESR remain key serological markers, with D-Dimer emerging as a notable addition.
  • Arthrocentesis with synovial fluid analysis and periprosthetic tissue biopsy (cultural and histological) offer the highest diagnostic accuracy.
  • The alpha-Defensin test is widely used but not yet in established criteria due to inconsistent accuracy reports.
  • Few diagnostic algorithms exist, with notable examples from AAOS, MSIS, and recent institutional/German Society publications.

Conclusions:

  • Accurate diagnosis of PJI requires a multi-faceted approach, integrating various diagnostic parameters.
  • Synovial fluid analysis and tissue biopsies are crucial for definitive PJI diagnosis.
  • Algorithmic approaches are essential tools to guide the diagnostic process effectively in clinical practice.