Diagnosis of periprosthetic hip infection: a clinical update

Area of Science:

• Orthopedics
• Infectious Diseases
• Medical Diagnostics

Background:

• Periprosthetic joint infection (PJI) is a severe complication of hip arthroplasty, incurring substantial costs and impacting patient health.
• Current diagnostic criteria for PJI lack consensus, complicating accurate identification and timely treatment.
• Challenges in PJI diagnosis stem from conflicting guidelines, numerous tests, and limited evidence, with no single diagnostic method offering perfect accuracy.

Approach:

• This review synthesizes current knowledge on the epidemiology, pathogenesis, classification, and diagnostic strategies for prosthetic hip infections.
• It examines traditional diagnostic methods, including clinical data, laboratory tests (serum and synovial fluid), microbiological cultures, histology, radiology, and intraoperative findings.
• Emerging diagnostic tools, such as novel biomarkers and molecular methods, are also considered for their potential in improving PJI detection.

Key Points:

• Accurate diagnosis of PJI relies on a multimodal approach, integrating various clinical, laboratory, microbiological, histological, radiological, and intraoperative data.
• Culture-negative PJI, occurring in 5-12% of cases, presents unique diagnostic hurdles due to low-grade infections or prior antibiotic use.
• Timely diagnosis of PJI is crucial, as delays are associated with significantly poorer patient outcomes.

Conclusions:

• The diagnosis of PJI remains challenging, necessitating a comprehensive evaluation combining established and novel diagnostic modalities.
• Continued research into standardized definitions and advanced diagnostic techniques is essential for improving PJI management.
• A multidisciplinary approach is vital for effectively diagnosing and treating periprosthetic joint infections following hip arthroplasty.