Periprosthetic Joint Infection: Modern Diagnostic Markers and Their Limitations

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Medical Diagnostics

Background:

• Joint arthroplasty (JA) significantly improves quality of life but carries the risk of periprosthetic joint infections (PJIs).
• PJIs lead to substantial morbidity, high costs, and increased mortality.
• Accurate and early PJI diagnosis is challenging due to overlapping symptoms and lack of definitive markers.

Purpose of the Study:

• To review and evaluate current diagnostic markers for periprosthetic joint infections (PJIs).
• To assess the diagnostic performance of traditional, synovial fluid, and molecular markers.
• To explore future advancements in PJI diagnostics.

Main Methods:

• Comprehensive literature search of systematic reviews, meta-analyses, and diagnostic accuracy studies.
• Evaluation of serum inflammatory markers (CRP, ESR).
• Assessment of synovial fluid biomarkers (leukocyte esterase, alpha-defensin, calprotectin) and molecular diagnostics (PCR, NGS).

Main Results:

• Traditional serum markers have lower sensitivity for chronic/low-grade infections.
• Synovial fluid biomarkers show improved diagnostic performance but face limitations in cost and standardization.
• Molecular diagnostics offer potential for detecting difficult organisms but are limited by cost and complexity.

Conclusions:

• A multi-modal diagnostic approach is recommended, integrating clinical assessment with various biomarkers.
• Standardization of diagnostic thresholds and improved accessibility of point-of-care tools are crucial.
• AI-enhanced models hold promise for improving diagnostic confidence and patient outcomes.