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Update on the role of pathology and laboratory medicine in diagnosing periprosthetic infection
Fermina M Mazzella1, Yaxia Zhang2, Thomas W Bauer3
1Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, USA.
Abstract:
Technological and implant design advances have helped reduce the frequency of aseptic total joint arthroplasty failure, but periprosthetic joint infections (PJI) remain a clinical important problem with high patient morbidity. Misinterpreting PJI as aseptic mechanical loosening commonly leads to unsatisfactory revision arthroplasty, persistent infection, and poor long-term results. While there is no single "gold standard" diagnostic test for PJI, recent collaborative efforts by Orthopaedic and Infectious Disease Societies have developed algorithms for diagnosing PJI. However, the efficacy of individual tests as well as diagnostic thresholds are controversial. We review the recommended thresholds for commonly used screening tests as well as tissue histopathology and confirmatory tests to diagnose periprosthetic infection. We also update lesser-known laboratory tests, and we briefly summarize rapidly evolving molecular tests to diagnose periprosthetic infection. Pathologists hold a critical role in assisting with PJI diagnosis, maintaining laboratory test quality and interpreting test results. Collaboration between clinicians and pathologists is essential to provide optimal patient care and reduce the burden of PJI.
Insights
Periprosthetic joint infections (PJI) are a significant complication after joint replacement surgery. Accurate diagnosis is crucial for effective treatment and improved patient outcomes.
Area of Science:
- Orthopedics
- Infectious Diseases
- Pathology
Background:
- Periprosthetic joint infections (PJI) are a major cause of total joint arthroplasty failure, leading to significant patient morbidity.
- Misdiagnosis of PJI as aseptic loosening results in suboptimal revision surgeries and persistent infections.
- Despite advances, diagnosing PJI remains challenging due to the lack of a single gold standard test.
Purpose of the Study:
- To review current diagnostic algorithms and thresholds for periprosthetic joint infections (PJI).
- To update knowledge on commonly used screening, histopathology, and confirmatory tests for PJI.
- To summarize emerging molecular diagnostic tests and highlight the role of pathologists in PJI diagnosis.
Main Methods:
- Review of recommended diagnostic thresholds for screening, histopathology, and confirmatory tests for PJI.
- Inclusion of lesser-known laboratory tests and a summary of rapidly evolving molecular diagnostic methods.
- Emphasis on the collaborative role of clinicians and pathologists in PJI diagnosis.
Main Results:
- Diagnostic thresholds for common PJI tests are debated, necessitating careful interpretation.
- A range of laboratory and molecular tests are available, with ongoing advancements.
- Pathologist expertise is vital for accurate PJI diagnosis and quality control.
Conclusions:
- Accurate diagnosis of PJI is critical to avoid poor outcomes in revision arthroplasty.
- Collaborative efforts and updated diagnostic strategies are essential for managing PJI.
- Pathologists play a key role in interpreting tests and ensuring diagnostic accuracy for PJI.
