Imaging approach to prosthetic joint infection
Meghan Jardon1, Jan Fritz2, Mohammad Samim2
1Department of Radiology, NYU Langone Medical Center, New York, NY, USA. meghan.jardon@nyulangone.org.
Abstract:
The diagnosis of prosthetic joint infection (PJI) remains challenging, despite multiple available laboratory tests for both serum and synovial fluid analysis. The clinical symptoms of PJI are not always characteristic, particularly in the chronic phase, and there is often significant overlap in symptoms with non-infectious forms of arthroplasty failure. Further exacerbating this challenge is lack of a universally accepted definition for PJI, with publications from multiple professional societies citing different diagnostic criteria. While not included in many of the major societies' guidelines for diagnosis of PJI, diagnostic imaging can play an important role in the workup of suspected PJI. In this article, we will review an approach to diagnostic imaging modalities (radiography, ultrasound, CT, MRI) in the workup of suspected PJI, with special attention to the limitations and benefits of each modality. We will also discuss the role that image-guided interventions play in the workup of these patients, through ultrasound and fluoroscopically guided joint aspirations. While there is no standard imaging algorithm that can universally applied to all patients with suspected PJI, we will discuss a general approach to diagnostic imaging and image-guided intervention in this clinical scenario.
Insights
Diagnosing prosthetic joint infection (PJI) is difficult due to overlapping symptoms and varied definitions. This review explores how imaging techniques like radiography, ultrasound, CT, and MRI aid in PJI diagnosis and management.
Area of Science:
- Orthopedics
- Radiology
- Infectious Diseases
Background:
- Prosthetic joint infection (PJI) diagnosis is challenging, with non-specific clinical signs and varying diagnostic criteria.
- Overlapping symptoms with non-infectious arthroplasty failure complicate accurate PJI identification.
- Lack of a universally accepted PJI definition further hinders diagnosis.
Purpose of the Study:
- To review diagnostic imaging modalities for suspected PJI.
- To discuss the benefits and limitations of radiography, ultrasound, CT, and MRI in PJI workup.
- To explore the role of image-guided interventions in managing suspected PJI.
Main Methods:
- Review of diagnostic imaging modalities: radiography, ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI).
- Discussion of image-guided interventions, including ultrasound and fluoroscopically guided joint aspirations.
- Analysis of the limitations and benefits of each imaging modality for PJI diagnosis.
Main Results:
- Diagnostic imaging, though not always in major guidelines, plays a crucial role in suspected PJI workup.
- Each imaging modality (radiography, ultrasound, CT, MRI) offers unique advantages and disadvantages for PJI detection.
- Image-guided joint aspirations are valuable interventions in the PJI diagnostic process.
Conclusions:
- A comprehensive approach integrating various imaging modalities and image-guided interventions is essential for diagnosing PJI.
- While no single algorithm fits all cases, a structured imaging strategy can improve PJI diagnosis.
- Further research may refine imaging protocols and the role of interventions in PJI management.
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