Imaging approach to prosthetic joint infection

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.